Individual
DR. RUSTY WADE SULLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4208 COLETTA DR, OKLAHOMA CITY, OK 73120-8317
(405) 751-9222
(405) 751-9223
Mailing address
4208 COLETTA DR, OKLAHOMA CITY, OK 73120-8317
(405) 751-9222
(405) 751-9223
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5243
OK
Other
Enumeration date
08/21/2006
Last updated
06/16/2008
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