Provider Demographics
NPI:1568686749
Name:TNT DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:TNT DENTAL SERVICES PLLC
Other - Org Name:WILLOW HILL DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER OF PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:TEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-289-7086
Mailing Address - Street 1:1829 S WOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447
Mailing Address - Country:US
Mailing Address - Phone:918-756-6500
Mailing Address - Fax:918-756-6505
Practice Address - Street 1:1829 S WOOD DRIVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447
Practice Address - Country:US
Practice Address - Phone:918-756-6500
Practice Address - Fax:918-756-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty