Provider Demographics
NPI:1760752901
Name:CHRIS MASTIN ORAL SURGERY, PLLC
Entity Type:Organization
Organization Name:CHRIS MASTIN ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-495-1800
Mailing Address - Street 1:9118 S TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2700
Mailing Address - Country:US
Mailing Address - Phone:918-495-1800
Mailing Address - Fax:918-495-1890
Practice Address - Street 1:9118 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2700
Practice Address - Country:US
Practice Address - Phone:918-495-1800
Practice Address - Fax:918-495-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty