Organization
MULLASSERIL PC
Active
Other names
Shawnee Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANAITA N MULLASSERIL BDS, MS (PRESIDENT)
(405) 878-8899
Entity
Organization
Contact information
Practice address
504 SHAWNEE MALL DR, SHAWNEE, OK 74804-1317
(405) 878-8899
(405) 878-8896
Mailing address
504 SHAWNEE MALL DR, SHAWNEE, OK 74804-1317
(405) 878-8899
(405) 878-8896
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
172
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200432170A
—
OK
Enumeration date
05/02/2012
Last updated
07/04/2012
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