Organization
ON THE CUSP PEDIATRIC DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN ROBERTS D.D.S., M.S. (OWNER/MEMBER)
(918) 970-4944
Entity
Organization
Contact information
Practice address
8222 E 103RD ST STE 133, TULSA, OK 74133-7027
(918) 970-4944
(918) 970-4593
Mailing address
8222 E 103RD ST, 133, TULSA, OK 74133-7081
(918) 970-4944
(918) 970-4593
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200258530A
—
OK
Enumeration date
05/24/2012
Last updated
08/14/2023
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