Provider Demographics
NPI:1881610020
Name:BELLER, KATHRYN ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ELLEN
Last Name:BELLER
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 1:7711 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4200
Mailing Address - Country:US
Mailing Address - Phone:918-461-2766
Mailing Address - Fax:918-461-0099
Practice Address - Street 1:7711 E 81ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4200
Practice Address - Country:US
Practice Address - Phone:918-461-2766
Practice Address - Fax:918-461-0099
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist