Healthcare Provider Details

I. General information

NPI: 1104272913
Provider Name (Legal Business Name): HEALTHY SMILES FAMILY DENTISTRY PLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 E 43RD CT STE 100
TULSA OK
74105-4155
US

IV. Provider business mailing address

1326 E 43RD CT STE 100
TULSA OK
74105-4154
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-0303
  • Fax: 918-749-0304
Mailing address:
  • Phone: 918-749-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5123
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. LORI HARE
Title or Position: OWNER PARTNER
Credential: DDS
Phone: 918-749-0303