Provider Demographics
NPI:1205139656
Name:DENTAL DESIGN STUDIO
Entity type:Organization
Organization Name:DENTAL DESIGN STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEEVIRAPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-321-6166
Mailing Address - Street 1:561 MERCHANT DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069
Mailing Address - Country:US
Mailing Address - Phone:405-321-6166
Mailing Address - Fax:405-329-3369
Practice Address - Street 1:561 MERCHANT DRIVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069
Practice Address - Country:US
Practice Address - Phone:405-321-6166
Practice Address - Fax:405-329-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty