Provider Demographics
NPI:1821192212
Name:TIWANA, GURBIR PAUL (DMD MD MS)
Entity Type:Individual
Prefix:
First Name:GURBIR
Middle Name:PAUL
Last Name:TIWANA
Suffix:
Gender:M
Credentials:DMD MD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 S I 35 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2715
Mailing Address - Country:US
Mailing Address - Phone:405-261-1002
Mailing Address - Fax:405-493-0995
Practice Address - Street 1:1000 N LINCOLN BLVD # 2000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-4955
Practice Address - Fax:405-271-4525
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80721223S0112X
KY38750204E00000X
TXF-253501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200506200AMedicaid
KY60002995Medicaid
KY64084601Medicaid
KY0053011Medicare ID - Type Unspecified
KY64084601Medicaid