Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4269 | OK |
NPI | 1013187186 |
---|---|
Provider Name | Denny W Southard |
First Address | Tulsa, OK 74136-8308 |
Second Address | Tulsa, OK 74136-8308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 05/03/2008 |