Provider Demographics
NPI:1700064219
Name:LAURA B. OUSLEY, D.D.S., PC
Entity Type:Organization
Organization Name:LAURA B. OUSLEY, D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:OUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-755-4450
Mailing Address - Street 1:11205 N MAY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6329
Mailing Address - Country:US
Mailing Address - Phone:405-755-4450
Mailing Address - Fax:405-755-4481
Practice Address - Street 1:11205 N MAY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6329
Practice Address - Country:US
Practice Address - Phone:405-755-4450
Practice Address - Fax:405-755-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty