=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386091247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMILE SOLUTIONS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2016
-----------------------------------------------------
Last Update Date | 05/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 24TH AVE SW
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-364-7385
-----------------------------------------------------
Fax | 405-447-8888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 24TH AVE SW
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-364-7385
-----------------------------------------------------
Fax | 405-447-8888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. BRETT LEEMASTER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 405-364-7385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5972
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------