Provider Demographics
NPI:1770824781
Name:A GREAT PLACE TO SMILE
Entity Type:Organization
Organization Name:A GREAT PLACE TO SMILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-683-8844
Mailing Address - Street 1:5510 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9038
Mailing Address - Country:US
Mailing Address - Phone:918-663-9990
Mailing Address - Fax:918-622-9991
Practice Address - Street 1:5510 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9038
Practice Address - Country:US
Practice Address - Phone:918-663-9990
Practice Address - Fax:918-622-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty