Provider Demographics
NPI:1952575961
Name:MJT DENTISTRY PLLC
Entity Type:Organization
Organization Name:MJT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-9946
Mailing Address - Street 1:4322 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3611
Mailing Address - Country:US
Mailing Address - Phone:918-743-9946
Mailing Address - Fax:
Practice Address - Street 1:4322 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3611
Practice Address - Country:US
Practice Address - Phone:918-743-9946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty