Organization
SOUTHARD FAMILY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOREN PAUL ISRAELSEN DDS (CEO)
(275) 773-0432
Entity
Organization
Contact information
Practice address
6333 S MEMORIAL DR, TULSA, OK 74133-1948
(918) 294-1144
Mailing address
6333 S MEMORIAL DR, TULSA, OK 74133-1948
(918) 294-1144
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
01/04/2022
Last updated
09/06/2023
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