Healthcare Provider Details

I. General information

NPI: 1528373867
Provider Name (Legal Business Name): ABSOLUTE SMILES FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 E. HWY. 37
TUTTLE OK
73089
US

IV. Provider business mailing address

4800 E. HWY. 37
TUTTLE OK
73089
US

V. Phone/Fax

Practice location:
  • Phone: 405-381-0900
  • Fax:
Mailing address:
  • Phone: 405-381-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number5944
License Number StateOK

VIII. Authorized Official

Name: MR. BRIAN GENE CHASTAIN
Title or Position: OWNER
Credential: DDS
Phone: 405-381-0900