Provider Demographics
NPI:1396622379
Name:MIDWEST CITY SPECIALISTS, LLC
Entity type:Organization
Organization Name:MIDWEST CITY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-232-7801
Mailing Address - Street 1:1621 MIDTOWN PL STE B
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6348
Mailing Address - Country:US
Mailing Address - Phone:405-982-2121
Mailing Address - Fax:405-561-0120
Practice Address - Street 1:1621 MIDTOWN PL STE B
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6348
Practice Address - Country:US
Practice Address - Phone:405-982-2121
Practice Address - Fax:405-561-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty