Provider Demographics
NPI:1013458744
Name:SKYVIEW FAMILY DENTAL
Entity Type:Organization
Organization Name:SKYVIEW FAMILY DENTAL
Other - Org Name:NEW HORIZONS PRACTICE MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBEDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-492-3003
Mailing Address - Street 1:5314 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6256
Mailing Address - Country:US
Mailing Address - Phone:918-492-3003
Mailing Address - Fax:
Practice Address - Street 1:5314 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6256
Practice Address - Country:US
Practice Address - Phone:918-492-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HORIZONS DENTAL PRACTICE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty