Provider Demographics
NPI:1629291463
Name:HARGETT, NESLIHAN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:NESLIHAN
Middle Name:E
Last Name:HARGETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NES
Other - Middle Name:E
Other - Last Name:HARGETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4515 E. 91ST STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137
Mailing Address - Country:US
Mailing Address - Phone:918-749-5033
Mailing Address - Fax:918-749-4394
Practice Address - Street 1:4515 E. 91ST STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137
Practice Address - Country:US
Practice Address - Phone:918-749-5033
Practice Address - Fax:918-749-4394
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55241223G0001X
OK2-5524122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20-4493551OtherTIN