Provider Demographics
NPI:1245255058
Name:SPOTTSWOOD, TRISTANNE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:TRISTANNE
Middle Name:MARIE
Last Name:SPOTTSWOOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13417 INVERNESS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7312
Mailing Address - Country:US
Mailing Address - Phone:910-494-5964
Mailing Address - Fax:
Practice Address - Street 1:5700 ARNOLD ST
Practice Address - Street 2:72 MDG/DS
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8105
Practice Address - Country:US
Practice Address - Phone:405-736-2000
Practice Address - Fax:405-736-2072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59101223G0001X
NC73321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice