Provider Demographics
NPI:1376722314
Name:WRANY R. SOUTHARD, D.D.S., P.C.
Entity Type:Organization
Organization Name:WRANY R. SOUTHARD, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-294-1144
Mailing Address - Street 1:6333 S MEMORIAL DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1948
Mailing Address - Country:US
Mailing Address - Phone:918-294-1144
Mailing Address - Fax:918-294-0884
Practice Address - Street 1:6333 S MEMORIAL DR
Practice Address - Street 2:SUITE G
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1948
Practice Address - Country:US
Practice Address - Phone:918-294-1144
Practice Address - Fax:918-294-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty