Healthcare Provider Details

I. General information

NPI: 1003742206
Provider Name (Legal Business Name): ZOEY MADISON SMILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 S WILSON ST
VINITA OK
74301-4245
US

IV. Provider business mailing address

115 MOCKINGBIRD LN
VINITA OK
74301-4617
US

V. Phone/Fax

Practice location:
  • Phone: 918-244-1002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-5568-1204363
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: