Organization
LARRY D. LANDER D.D.S.,M.S. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA E SAMS (CONTRACT COORDINATOR)
(918) 494-8634
Entity
Organization
Contact information
Practice address
6132 E 61ST ST, TULSA, OK 74136-2117
(918) 494-8634
(918) 494-8636
Mailing address
6132 E 61ST ST, TULSA, OK 74136-2117
(918) 494-8634
(918) 494-8636
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3818
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100174460A
—
OK
Enumeration date
03/18/2010
Last updated
03/18/2010
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