Provider Demographics
NPI:1659548188
Name:JOHN F CARLETTI,DDS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:JOHN F CARLETTI,DDS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUPRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-224-0369
Mailing Address - Street 1:635 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066
Mailing Address - Country:US
Mailing Address - Phone:918-224-0369
Mailing Address - Fax:918-224-9518
Practice Address - Street 1:635 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066
Practice Address - Country:US
Practice Address - Phone:918-224-0369
Practice Address - Fax:918-224-9518
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN F CARLETTI, DDS A PROFESSIOAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty