Provider Demographics
NPI:1699850198
Name:HOWARD D IBA DDS MD INC
Entity Type:Organization
Organization Name:HOWARD D IBA DDS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:DEMMISTOH
Authorized Official - Last Name:IBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-492-5353
Mailing Address - Street 1:5010 E 68TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74156
Mailing Address - Country:US
Mailing Address - Phone:918-492-5353
Mailing Address - Fax:918-492-5374
Practice Address - Street 1:5010 E 68TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74156
Practice Address - Country:US
Practice Address - Phone:918-492-5353
Practice Address - Fax:918-492-5374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty