Provider Demographics
NPI:1750880399
Name:MIDWEST SMILES, PLLC
Entity type:Organization
Organization Name:MIDWEST SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:V
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-733-8665
Mailing Address - Street 1:9321 E RENO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3321
Mailing Address - Country:US
Mailing Address - Phone:405-733-8665
Mailing Address - Fax:
Practice Address - Street 1:9321 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3321
Practice Address - Country:US
Practice Address - Phone:405-733-8665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental