1659548188 NPI number — JOHN F CARLETTI,DDS A PROFESSIONAL CORP

Table of content: (NPI 1659548188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659548188 NPI number — JOHN F CARLETTI,DDS A PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN F CARLETTI,DDS A PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659548188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
635 S MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAPULPA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-224-0369
Provider Business Mailing Address Fax Number:
918-224-9518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
635 S MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAPULPA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-224-0369
Provider Business Practice Location Address Fax Number:
918-224-9518
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DUPRIEST
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
918-224-0369

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3005 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com