Jay Wade Pettit, D.D.S.
Individual provider Active NPI General Practice Dentistry · Bristow, OK
NPI 1154527265 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1154527265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4885 (OK)
- Practice address
- 112 N Elm St
Bristow, OK 74010-2424 - Phone
- (918) 367-5900
- Fax
- (918) 367-3226
- NPI assigned
- Jun 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jay W. Pettit DDS Inc. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4885 | OK | Yes |
Addresses
Primary practice location
112 N Elm St
Bristow, OK 74010-2424
Mailing address
112 N Elm St
Bristow, OK 74010-2424
Phone (918) 367-5900
Other providers in Bristow, OK
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- Elizabeth Norwood
- Osu Center for Health Sciences
- Outside the Box Speech Services, LLC
- Angi Palmer-Manire
- Pharmology Bristow LLC
- Physicians Choice Dialysis of Bristow LLC
- Physicians Pathology Inc
- Kaley Pieratt
- Sarah Brooke Pinson
All providers in Bristow, OK · General Practice Dentistry in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.