Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5360 | OK |
NPI | 1164585519 |
---|---|
Provider Name | Paul Mathews Mullasseril |
First Address | Oklahoma City, OK 73190-0001 |
Second Address | Oklahoma City, OK 73117-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 29/08/2008 |