Provider Demographics
NPI:1457478380
Name:WITHEY, OKSANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OKSANA
Middle Name:
Last Name:WITHEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 S EAST ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1992
Mailing Address - Country:US
Mailing Address - Phone:317-782-4463
Mailing Address - Fax:
Practice Address - Street 1:5222 S EAST ST
Practice Address - Street 2:SUITE 7
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1992
Practice Address - Country:US
Practice Address - Phone:317-782-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006843A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice