Provider Demographics
NPI:1548556327
Name:LAWTON ENDODONTICS
Entity Type:Organization
Organization Name:LAWTON ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-248-3636
Mailing Address - Street 1:8504 NW CACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9604
Mailing Address - Country:US
Mailing Address - Phone:580-248-3636
Mailing Address - Fax:580-248-3533
Practice Address - Street 1:8504 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9604
Practice Address - Country:US
Practice Address - Phone:580-248-3636
Practice Address - Fax:580-248-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty