Provider Demographics
NPI:1558424788
Name:RATZLAFF, ALISA BURROSS (DDS)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:BURROSS
Last Name:RATZLAFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 BLUE SAGE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5348
Mailing Address - Country:US
Mailing Address - Phone:940-613-6940
Mailing Address - Fax:
Practice Address - Street 1:13901 PARKWAY COMMONS DR STE D
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6225
Practice Address - Country:US
Practice Address - Phone:940-613-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2227581223G0001X
OK72731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1558424788OtherDENTIST
TX1558424788OtherDENTIST