Healthcare Provider Details

I. General information

NPI: 1467574004
Provider Name (Legal Business Name): SMILING FACES PEDIATRIC DENTISTRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 N. PORTLAND
OKLAHOMA CITY OK
73112
US

IV. Provider business mailing address

5222 N. PORTLAND
OKLAHOMA CITY OK
73112
US

V. Phone/Fax

Practice location:
  • Phone: 405-947-1525
  • Fax: 405-947-6716
Mailing address:
  • Phone: 405-947-1525
  • Fax: 405-947-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5609
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2933
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5590
License Number StateOK

VIII. Authorized Official

Name: MR. WILLIAM R FARMER
Title or Position: OWNER
Credential: DDS
Phone: 918-521-0473