Provider Demographics
NPI:1083747240
Name:PRATTVILE FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:PRATTVILE FAMILY DENTISTRY PC
Other - Org Name:GALLERIA OF SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-245-5976
Mailing Address - Street 1:104 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-2709
Mailing Address - Country:US
Mailing Address - Phone:918-245-5976
Mailing Address - Fax:918-245-2218
Practice Address - Street 1:104 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-2709
Practice Address - Country:US
Practice Address - Phone:918-245-5976
Practice Address - Fax:918-245-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty