Provider Demographics
NPI:1134135239
Name:HASTY, NEIL (DDS)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:HASTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2315
Mailing Address - Country:US
Mailing Address - Phone:918-835-9347
Mailing Address - Fax:
Practice Address - Street 1:5424 S MEMORIAL DR
Practice Address - Street 2:SUITE D-1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9003
Practice Address - Country:US
Practice Address - Phone:918-280-0880
Practice Address - Fax:918-280-0008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK58861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice