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Organization

OU COLLEGE OF DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TYLER HOLT D.D.S. (GRA)
(405) 271-4148
Entity
Organization

Contact information

Practice address
1201 N STONEWALL AVE, OKLAHOMA CITY, OK 73117-1214
(405) 271-4148
Mailing address
1201 N STONEWALL AVE, OKLAHOMA CITY, OK 73117-1214

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
6591
OK

Other

Enumeration date
06/30/2015
Last updated
06/30/2015
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