Provider Demographics
NPI:1669621629
Name:SMILE CENTER, INC.
Entity type:Organization
Organization Name:SMILE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-664-3366
Mailing Address - Street 1:4528 S SHERIDAN RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1140
Mailing Address - Country:US
Mailing Address - Phone:918-664-3366
Mailing Address - Fax:918-664-0933
Practice Address - Street 1:4528 S SHERIDAN RD
Practice Address - Street 2:SUITE 112
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1140
Practice Address - Country:US
Practice Address - Phone:918-664-3366
Practice Address - Fax:918-664-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3343261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental