Provider Demographics
NPI:1730105511
Name:MCCREIGHT, TOMMY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:LEE
Last Name:MCCREIGHT
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 1:502 W CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4212
Mailing Address - Country:US
Mailing Address - Phone:918-775-3742
Mailing Address - Fax:
Practice Address - Street 1:502 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4212
Practice Address - Country:US
Practice Address - Phone:918-775-3742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK30241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice