Provider Demographics
NPI:1629550595
Name:SMILE OF OKLAHOMA PC
Entity Type:Organization
Organization Name:SMILE OF OKLAHOMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-848-7566
Mailing Address - Street 1:414 UNION STREET 8TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219
Mailing Address - Country:US
Mailing Address - Phone:800-848-7566
Mailing Address - Fax:
Practice Address - Street 1:414 UNION STREET 8TH FLOOR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219
Practice Address - Country:US
Practice Address - Phone:800-848-7566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty