Provider Demographics
NPI:1881860690
Name:GARY H SMITH DDS PC
Entity Type:Organization
Organization Name:GARY H SMITH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HAYWOOD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-280-0880
Mailing Address - Street 1:5424 S MEMORIAL DR
Mailing Address - Street 2:SUITE D1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9003
Mailing Address - Country:US
Mailing Address - Phone:918-280-0880
Mailing Address - Fax:918-280-0008
Practice Address - Street 1:5424 S MEMORIAL DR
Practice Address - Street 2:SUITE D1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9003
Practice Address - Country:US
Practice Address - Phone:918-280-0880
Practice Address - Fax:918-280-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100637250CMedicaid