Individual
KYLE SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
3150 E 41ST ST, SUITE 112, TULSA, OK 74105-3717
(918) 743-2321
(918) 749-5121
Mailing address
3150 E 41ST ST, SUITE 112, TULSA, OK 74105-3717
(918) 743-2321
(918) 749-5121
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5410
OK
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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