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General NPI Number Information
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NPI Number | 1043121387
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Entity Type | Organization
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Legal Business Name | BRIGHT SMILES PEDIATRIC DENTAL OF MUSKOGEE LLC
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 3300 CHANDLER RD STE 111
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City | MUSKOGEE
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State | OK
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Zip | 74403-4909
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Country | US
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Telephone | 405-942-4445
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 CHANDLER RD STE 111
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City | MUSKOGEE
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State | OK
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Zip | 74403-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOREN ISRAELSEN
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Credential | DDS
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Telephone | 435-232-7801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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