Healthcare Provider Details

I. General information

NPI: 1043121387
Provider Name (Legal Business Name): BRIGHT SMILES PEDIATRIC DENTAL OF MUSKOGEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 CHANDLER RD STE 111
MUSKOGEE OK
74403-4909
US

IV. Provider business mailing address

3300 CHANDLER RD STE 111
MUSKOGEE OK
74403-4909
US

V. Phone/Fax

Practice location:
  • Phone: 405-942-4445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LOREN ISRAELSEN
Title or Position: OWNER
Credential: DDS
Phone: 435-232-7801