Provider Demographics
NPI:1508940743
Name:GERKIN, STEPHEN JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES
Last Name:GERKIN
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 1:4433 S HARVARD AVE.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2604
Mailing Address - Country:US
Mailing Address - Phone:918-742-8775
Mailing Address - Fax:918-742-7281
Practice Address - Street 1:4433 S HARVARD AVE.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2604
Practice Address - Country:US
Practice Address - Phone:918-742-8775
Practice Address - Fax:918-742-7281
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice