Provider Demographics
NPI:1598969487
Name:TALIHINA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:TALIHINA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCNATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-567-3961
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-0695
Mailing Address - Country:US
Mailing Address - Phone:918-230-8105
Mailing Address - Fax:
Practice Address - Street 1:200 DALLAS ST
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-2402
Practice Address - Country:US
Practice Address - Phone:918-567-3961
Practice Address - Fax:918-567-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100736120AMedicaid