Provider Demographics
NPI:1326421298
Name:REGION DENTAL, LLC
Entity Type:Organization
Organization Name:REGION DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NOAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-742-5521
Mailing Address - Street 1:3210 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1811
Mailing Address - Country:US
Mailing Address - Phone:918-742-5521
Mailing Address - Fax:918-742-5522
Practice Address - Street 1:3210 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1811
Practice Address - Country:US
Practice Address - Phone:918-742-5521
Practice Address - Fax:918-742-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty