Provider Demographics
NPI:1467574004
Name:SMILING FACES PEDIATRIC DENTISTRY INC
Entity Type:Organization
Organization Name:SMILING FACES PEDIATRIC DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-521-0473
Mailing Address - Street 1:5222 N. PORTLAND
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-947-1525
Mailing Address - Fax:405-947-6716
Practice Address - Street 1:5222 N. PORTLAND
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-947-1525
Practice Address - Fax:405-947-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56091223G0001X
OK29331223P0221X
OK55901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100730090AMedicaid