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General NPI Number Information
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NPI Number | 1245406529
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Entity Type | Organization
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Legal Business Name | MASTERPIECE SMILES
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 8908 S YALE AVE #430
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City | TULSA
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State | OK
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Zip | 74137-3557
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Country | US
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Telephone | 918-496-2481
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Fax | 918-496-3749
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Provider Business Mailing Address
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Address Line | 8908 S YALE AVE #430
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City | TULSA
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State | OK
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Zip | 74137-3557
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Country | US
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Telephone | 918-496-2481
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Fax | 918-496-3749
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAN L COBBLE
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Credential | D.D.S.
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Telephone | 918-496-2481
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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 | 3457
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License Number State | OK
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