Provider Demographics
NPI:1821257890
Name:TULSA COSMETIC DENTAL CENTER
Entity Type:Organization
Organization Name:TULSA COSMETIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-496-1919
Mailing Address - Street 1:9445 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5792
Mailing Address - Country:US
Mailing Address - Phone:918-496-1919
Mailing Address - Fax:
Practice Address - Street 1:9445 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5792
Practice Address - Country:US
Practice Address - Phone:918-496-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty