Provider Demographics
NPI:1114094372
Name:TULSA GALLERIA OF SMILES LLC
Entity Type:Organization
Organization Name:TULSA GALLERIA OF SMILES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:EMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-496-8010
Mailing Address - Street 1:7320 S YALE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7092
Mailing Address - Country:US
Mailing Address - Phone:918-496-8010
Mailing Address - Fax:918-496-9536
Practice Address - Street 1:7320 S YALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7092
Practice Address - Country:US
Practice Address - Phone:918-496-8010
Practice Address - Fax:918-496-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty