Provider Demographics
NPI:1245435874
Name:LUTZ, FREDERICK KARL (DDS)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:KARL
Last Name:LUTZ
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 1:10821 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6916
Mailing Address - Country:US
Mailing Address - Phone:405-721-6250
Mailing Address - Fax:405-721-6259
Practice Address - Street 1:10821 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6916
Practice Address - Country:US
Practice Address - Phone:405-721-6250
Practice Address - Fax:405-721-6259
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice