Provider Demographics
NPI:1245406529
Name:MASTERPIECE SMILES
Entity Type:Organization
Organization Name:MASTERPIECE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-496-2481
Mailing Address - Street 1:8908 S YALE AVE
Mailing Address - Street 2:#430
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3557
Mailing Address - Country:US
Mailing Address - Phone:918-496-2481
Mailing Address - Fax:918-496-3749
Practice Address - Street 1:8908 S YALE AVE
Practice Address - Street 2:#430
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3557
Practice Address - Country:US
Practice Address - Phone:918-496-2481
Practice Address - Fax:918-496-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3457261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental