Individual
WESLEY NEILL BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6112 E 61ST STREET, TULSA, OK 74136
(918) 745-0500
(918) 712-9913
Mailing address
6112 E 61ST STREET, TULSA, OK 74136
(918) 745-0500
(918) 712-9913
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5573
OK
Other
Enumeration date
02/23/2006
Last updated
05/10/2018
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