Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN20350 | FL |
Y | 208200000X | Surgeon | 32110 | OK |
Y | 208600000X | Surgeon | 32110 | OK |
NPI | 1023329901 |
---|---|
Provider Name | Dr. Armando Retana |
First Address | Tulsa, OK 74133-6016 |
Second Address | Tulsa, OK 74133-6016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 08/08/2016 |