Provider Demographics
NPI:1255447355
Name:CASLER, CONRAD C JR (DDS)
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:C
Last Name:CASLER
Suffix:JR
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 1:6911 S 66TH EAST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1748
Mailing Address - Country:US
Mailing Address - Phone:918-477-7677
Mailing Address - Fax:918-493-1991
Practice Address - Street 1:6911 S 66TH EAST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1748
Practice Address - Country:US
Practice Address - Phone:918-477-7677
Practice Address - Fax:918-493-1991
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4403122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist