Provider Demographics
NPI:1295749976
Name:SESSOM, JEFFERY WADE
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:WADE
Last Name:SESSOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 S HARVARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2616
Mailing Address - Country:US
Mailing Address - Phone:918-742-2096
Mailing Address - Fax:918-749-2611
Practice Address - Street 1:4415 S HARVARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2616
Practice Address - Country:US
Practice Address - Phone:918-742-2096
Practice Address - Fax:918-749-2611
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice