Provider Demographics
NPI:1922300789
Name:VROOME ORTHODONTICS
Entity Type:Organization
Organization Name:VROOME ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VROOME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:918-742-7361
Mailing Address - Street 1:2117 S ATLANTA PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1709
Mailing Address - Country:US
Mailing Address - Phone:918-271-7361
Mailing Address - Fax:
Practice Address - Street 1:2117 S ATLANTA PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1709
Practice Address - Country:US
Practice Address - Phone:918-271-7361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55967302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization