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General NPI Number Information
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NPI Number | 1629474127
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Entity Type | Organization
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Legal Business Name | SMILE GALAXY ORTHODONTICS
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 10001 S PENNSYLVANIA AVE BLDG P SUITE #130
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-6923
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Country | US
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Telephone | 405-759-3724
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Fax | 405-759-3728
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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 | 405-759-3724
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Fax | 405-759-3728
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Authorized Official
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Title or Position | OWNER
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Name | MR. ROBERT BRIAN MOLLOY
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Credential | DDS
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 185
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License Number State | OK
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