Individual
DR. COURTNEY MICKLE-DITTRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1334 N LANSING AVE, TULSA, OK 74106-5907
(918) 587-2171
Mailing address
9527 N 143RD EAST CT, OWASSO, OK 74055-4950
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7904
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2023
Last updated
09/26/2024
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