Provider Demographics
NPI:1689714677
Name:MANUEL, DALE (DDS)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:MANUEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 S. SHERIDAN RD
Mailing Address - Street 2:MY DENTIST
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1102
Mailing Address - Country:US
Mailing Address - Phone:918-551-7216
Mailing Address - Fax:918-551-7586
Practice Address - Street 1:3101 S. SHERIDAN RD
Practice Address - Street 2:MY DENTIST
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1102
Practice Address - Country:US
Practice Address - Phone:918-551-7216
Practice Address - Fax:918-551-7586
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice