Provider Demographics
NPI:1659785343
Name:JAN, MEHWISH NOUMAN (DDS)
Entity Type:Individual
Prefix:
First Name:MEHWISH
Middle Name:NOUMAN
Last Name:JAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 TECUMSEH MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-366-6277
Mailing Address - Fax:
Practice Address - Street 1:1200 S AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4866
Practice Address - Country:US
Practice Address - Phone:877-970-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice