Provider Demographics
NPI:1679748354
Name:MIDTOWN DENTISTRY,INC
Entity Type:Organization
Organization Name:MIDTOWN DENTISTRY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-8539
Mailing Address - Street 1:3345 S HARVARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1812
Mailing Address - Country:US
Mailing Address - Phone:918-743-8539
Mailing Address - Fax:918-743-5270
Practice Address - Street 1:3345 S HARVARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1812
Practice Address - Country:US
Practice Address - Phone:918-743-8539
Practice Address - Fax:918-743-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty