Provider Demographics
NPI:1598935793
Name:CHRISTOPHER D. TRICINELLA, D.D.S., PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER D. TRICINELLA, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TRICINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-628-0834
Mailing Address - Street 1:6128 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-2117
Mailing Address - Country:US
Mailing Address - Phone:918-628-0834
Mailing Address - Fax:918-628-0838
Practice Address - Street 1:6128 E 61ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-2117
Practice Address - Country:US
Practice Address - Phone:918-628-0834
Practice Address - Fax:918-628-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty