Provider Demographics
NPI:1912380643
Name:NATHAN D POWELL DDS PLLC
Entity Type:Organization
Organization Name:NATHAN D POWELL DDS PLLC
Other - Org Name:FOREFRONT DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-664-6845
Mailing Address - Street 1:5424 S MEMORIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9003
Mailing Address - Country:US
Mailing Address - Phone:918-664-6845
Mailing Address - Fax:918-664-6847
Practice Address - Street 1:5424 S MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9003
Practice Address - Country:US
Practice Address - Phone:918-664-6845
Practice Address - Fax:918-664-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty