Organization
JOHNSON AND SOUTHARD ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURIE LYNN SOUTHARD DDS (PRESIDENT/ENDODONTIST)
(918) 493-3880
Entity
Organization
Contact information
Practice address
5010 E 68TH ST, SUITE 104, TULSA, OK 74136-3323
(918) 493-3880
(918) 492-8564
Mailing address
5010 E 68TH ST, SUITE 104, TULSA, OK 74136-3323
(918) 493-3880
(918) 492-8564
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
5119
OK
Other
Enumeration date
12/17/2008
Last updated
12/17/2008
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