Provider Demographics
NPI:1154328227
Name:HACKLER, JAMES WILSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILSON
Last Name:HACKLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 E. 51 ST.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3603
Mailing Address - Country:US
Mailing Address - Phone:918-492-1780
Mailing Address - Fax:918-492-7823
Practice Address - Street 1:3811 E. 51 ST.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3603
Practice Address - Country:US
Practice Address - Phone:918-492-1780
Practice Address - Fax:918-492-7823
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100116800AMedicaid