Provider Demographics
NPI:1154851392
Name:TREANOR, JOSEPH SOLOMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SOLOMON
Last Name:TREANOR
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 1:309 WOODS LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1159
Mailing Address - Country:US
Mailing Address - Phone:580-504-7586
Mailing Address - Fax:
Practice Address - Street 1:1610 WALNUT DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2331
Practice Address - Country:US
Practice Address - Phone:580-504-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist