Individual
LARRY D WITHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6001 NW 120TH CT STE 8, OKLAHOMA CITY, OK 73162-1700
(405) 721-5757
(405) 721-6783
Mailing address
6001 NW 120TH CT STE 8, OKLAHOMA CITY, OK 73162-1700
(405) 721-5757
(405) 721-6783
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4151
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731163865001
BLUE CROSS BLUE SHIELD
OK
01
—
797388
UNITED CONCORDIA
OK
Enumeration date
08/18/2006
Last updated
07/08/2007
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