Provider Demographics
NPI:1669467270
Name:PARLEY HUBLER JR DDS PC
Entity Type:Organization
Organization Name:PARLEY HUBLER JR DDS PC
Other - Org Name:DIAMOND SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PARLEY
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:HUBLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-775-3200
Mailing Address - Street 1:1506 W CHICKASAW AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-7200
Mailing Address - Country:US
Mailing Address - Phone:918-775-3200
Mailing Address - Fax:918-775-0080
Practice Address - Street 1:1506 W CHICKASAW AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-7200
Practice Address - Country:US
Practice Address - Phone:918-775-3200
Practice Address - Fax:918-775-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100091070AMedicaid