Provider Demographics
NPI:1245447960
Name:TODD, TOM NEAL
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:NEAL
Last Name:TODD
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:NEAL
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:10906 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-6207
Mailing Address - Country:US
Mailing Address - Phone:405-691-2102
Mailing Address - Fax:
Practice Address - Street 1:6002 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1602
Practice Address - Country:US
Practice Address - Phone:405-631-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK40541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice