Individual
DR. PAUL EDWARD RADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
217 N WATER AVE, TAHLEQUAH, OK 74464-2825
(918) 456-3521
Mailing address
217 N WATER AVE, TAHLEQUAH, OK 74464-2825
(918) 456-3521
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4318
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4318
DENTAL LICENSE
OK
Enumeration date
07/06/2006
Last updated
07/08/2007
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