Provider Demographics
NPI:1518414523
Name:SMILE STOP DENTAL OF SOUTWEST TULSA
Entity Type:Organization
Organization Name:SMILE STOP DENTAL OF SOUTWEST TULSA
Other - Org Name:DR. TARR'S SMILE STOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-336-1030
Mailing Address - Street 1:5676 W SKELLY DR STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-9134
Mailing Address - Country:US
Mailing Address - Phone:918-446-0128
Mailing Address - Fax:
Practice Address - Street 1:5676 W SKELLY DR STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-9134
Practice Address - Country:US
Practice Address - Phone:918-446-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5779261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5779OtherDENTAL LICENSE