Healthcare Provider Details

I. General information

NPI: 1336900638
Provider Name (Legal Business Name): SMILES FAMILY DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9006 E 62ND ST
TULSA OK
74133-6371
US

IV. Provider business mailing address

10950 S 500 RD
MIAMI OK
74354-6002
US

V. Phone/Fax

Practice location:
  • Phone: 918-249-0249
  • Fax:
Mailing address:
  • Phone: 918-541-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JAMIE WILLIAMS
Title or Position: PRESIDENT
Credential: DDS
Phone: 918-541-5888