Individual
MARK HARRISON HERDADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
221 E DOWNING ST, TAHLEQUAH, OK 74464-3011
(918) 708-1601
Mailing address
1515 E 21ST ST, TULSA, OK 74114-1339
(918) 313-3918
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8199
OK
1223G0001X
General Practice Dentistry
Primary
8199
OK
1223G0001X
General Practice Dentistry
Primary
TBD
OK
Other
Enumeration date
04/08/2026
Last updated
06/20/2026
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