Provider Demographics
NPI:1922356310
Name:DYNAMIC MEDICAL SOLUTIONS
Entity Type:Organization
Organization Name:DYNAMIC MEDICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODORIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-570-9962
Mailing Address - Street 1:3500 S BOULEVARD BLDG B
Mailing Address - Street 2:SUITE 18B
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5486
Mailing Address - Country:US
Mailing Address - Phone:405-570-9962
Mailing Address - Fax:
Practice Address - Street 1:3500 S BOULEVARD BLDG B
Practice Address - Street 2:SUITE 18B
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5486
Practice Address - Country:US
Practice Address - Phone:405-570-9962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty