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General NPI Number Information
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NPI Number | 1023034451
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Entity Type | Organization
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Legal Business Name | SMILE GALAXY PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 9801 S. PENNSYLVANIA
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-6925
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Country | US
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Telephone | 405-692-1222
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Fax | 405-703-0930
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Provider Business Mailing Address
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Address Line | PO BOX 892290
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City | OKLAHOMA CITY
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State | OK
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Zip | 73189-2290
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Country | US
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Telephone | 405-692-1222
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Fax | 405-703-0930
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. ROBERT BRIAN MOLLOY
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Credential | D.D.S.
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Telephone | 405-692-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5436
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License Number State | OK
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