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General NPI Number Information
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NPI Number | 1659960649
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Entity Type | Organization
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Legal Business Name | SMILE DOCTORS OF OKLAHOMA PC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 4550 S HARVARD AVE
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City | TULSA
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State | OK
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Zip | 74135-2906
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Country | US
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Telephone | 918-749-8817
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 674459
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City | DALLAS
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State | TX
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Zip | 75267-4459
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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 | PRESIDENT
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Name | GREGORY GOGGANS
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Credential |
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Telephone | 918-749-8817
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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 |
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License Number State |
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