Provider Demographics
NPI:1245660968
Name:OKC SMILES, LLC
Entity type:Organization
Organization Name:OKC SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:
Authorized Official - Last Name:STALDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-728-1278
Mailing Address - Street 1:930 SW 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170
Mailing Address - Country:US
Mailing Address - Phone:405-634-7303
Mailing Address - Fax:
Practice Address - Street 1:930 SW 107TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-634-7303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental