Tulsa Modern Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TULSA MODERN DENTAL

Practice address

3345 S Harvard Ave
Suite 302
Tulsa, OK 74135-1812

Phone

(918) 591-3535

NPI assigned

Aug 18, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mariam G Hanna, D.D.S.

Title

Doctor of Dental Surgery

Phone

(918) 591-3535

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471478400000",
    "number": "1154876258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 S HARVARD AVE",
            "address_2": "SUITE 302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741351812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 S HARVARD AVE",
            "address_2": "SUITE 302",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741351812",
            "telephone_number": "918-591-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULSA MODERN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-18",
        "last_updated": "2016-08-18",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DOCTOR OF DENTAL SURGERY",
        "authorized_official_telephone_number": "918-591-3535",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.