Provider Demographics
NPI:1053588285
Name:TINA J MOREHART DDS PC
Entity type:Organization
Organization Name:TINA J MOREHART DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MOREHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-208-8844
Mailing Address - Street 1:500 N WALKER AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102
Mailing Address - Country:US
Mailing Address - Phone:405-208-8844
Mailing Address - Fax:405-208-8846
Practice Address - Street 1:500 N WALKER AVE STE 500
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102
Practice Address - Country:US
Practice Address - Phone:405-208-8844
Practice Address - Fax:405-208-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty