Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7431 | OK |
NPI | 1003486754 |
---|---|
Provider Name | Dr. Crystal Rajan |
First Address | Oklahoma City, OK 73102-1850 |
Second Address | Oklahoma City, OK 73104-5007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1778950 | (05) | OK |