Provider Demographics
NPI:1114445285
Name:T-TOWN SMILES, PC
Entity Type:Organization
Organization Name:T-TOWN SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANBRUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-481-4922
Mailing Address - Street 1:6565 S YALE AVE # 1107
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6565 S YALE AVE # 1107
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8327
Practice Address - Country:US
Practice Address - Phone:918-481-4922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty