Individual
DR. KIPPY GLYNN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
(918) 458-3628
Mailing address
100 S BLISS AVE, TAHLEQUAH, OK 74464-2512
(918) 458-3100
(918) 458-3628
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
75052
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1305052
—
OK
Enumeration date
12/18/2006
Last updated
07/09/2007
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