Provider Demographics
NPI:1417052689
Name:HEALTHY SMILES FAMILY DENTISTRY PLLP
Entity Type:Organization
Organization Name:HEALTHY SMILES FAMILY DENTISTRY PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-343-4300
Mailing Address - Street 1:600 W WILL ROGERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6825
Mailing Address - Country:US
Mailing Address - Phone:918-343-4300
Mailing Address - Fax:918-342-4697
Practice Address - Street 1:600 W WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6825
Practice Address - Country:US
Practice Address - Phone:918-343-4300
Practice Address - Fax:918-342-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5138122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty