Healthcare Provider Details

I. General information

NPI: 1285636027
Provider Name (Legal Business Name): RONALD K. GIRLINGHOUSE D.D.S, P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 BROWN BLVD
SALLISAW OK
74955-7263
US

IV. Provider business mailing address

3109 HEATHER OAKS WAY
FORT SMITH AR
72908-9313
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-5775
  • Fax:
Mailing address:
  • Phone: 918-775-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5312
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: