Individual
DR. TYSON HEATH ROULSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1226 W BROADWAY ST, DRUMRIGHT, OK 74030-5826
(918) 352-3312
Mailing address
19434 W 105TH ST S, SAPULPA, OK 74066-8055
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6407
OK
Other
Enumeration date
06/27/2012
Last updated
06/27/2012
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