Individual
DR. JONATHAN CHU-MING SOETANDIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5510 E 41ST ST STE C, TULSA, OK 74135-6009
(918) 641-4635
Mailing address
215 S LOOP 336 W, CONROE, TX 77304-3305
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7387
OK
1223G0001X
General Practice Dentistry
Primary
37917
TX
Other
Enumeration date
09/03/2020
Last updated
12/14/2021
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