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General NPI Number Information
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NPI Number | 1881860690
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Entity Type | Organization
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Legal Business Name | GARY H SMITH DDS PC
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 5424 S MEMORIAL DR SUITE D1
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City | TULSA
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State | OK
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Zip | 74145-9003
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Country | US
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Telephone | 918-280-0880
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Fax | 918-280-0008
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Provider Business Mailing Address
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Address Line | 5424 S MEMORIAL DR SUITE D1
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City | TULSA
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State | OK
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Zip | 74145-9003
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Country | US
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Telephone | 918-280-0880
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Fax | 918-280-0008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY HAYWOOD SMITH
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Credential | DDS
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Telephone | 918-280-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5156
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License Number State | OK
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