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NPI Code Detail

MEDICARE: ALL SMILES DENTAL OF ADA PC

MEDICARE: ALL SMILES DENTAL OF ADA PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1457978546
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALL SMILES DENTAL OF ADA PC
Provider Business Mailing Address
First Line : 1212 ARLINGTON ST
Second Line :
City : ADA
State : OK
Zip : 74820-4045
Country : US
Telephone Number : 214-632-7503
Fax Number : 580-927-2332
Provider Business Practice Location Address
First Line : 1212 ARLINGTON ST
Second Line :
City : ADA
State : OK
Zip : 74820-4045
Country : US
Telephone Number : 580-332-6767
Fax Number : 580-927-2332
Authorized Official
Title or Position : PRESIDENT
Name : DR. LENA R CRAIG
Credential : DDS
Telephone Number : 214-632-7503
Provider Enumeration Date : 07/06/2020
Last Update Date : 07/06/2020

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