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General NPI Number Information
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NPI Number | 1316347016
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Entity Type | Organization
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Legal Business Name | ADA SMILE PLACE, PLLC
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 1801 ARLINGTON ST
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City | ADA
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State | OK
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Zip | 74820-2814
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Country | US
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Telephone | 580-332-1660
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Fax | 580-421-9009
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Provider Business Mailing Address
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Address Line | 1801 ARLINGTON ST
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City | ADA
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State | OK
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Zip | 74820-2814
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Country | US
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Telephone | 580-332-1660
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Fax | 580-421-9009
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Authorized Official
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Title or Position | PARTNER/DENTIST
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Name | BENJAMIN FRANKLIN EDWARDS III
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Credential | D.D.S.
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Telephone | 580-332-1660
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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 | 6279
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 4105
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License Number State | OK
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