MEDICARE: A BETTER SMILE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	OK5700	OK

General Provider Information

NPI Number	:	1417108432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BETTER SMILE, PC

Provider Business Mailing Address
First Line	:	1201 E 42ND PL
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-3849
Country	:	US
Telephone Number	:	918-346-1900
Fax Number	:	918-347-5748

Provider Business Practice Location Address
First Line	:	3902 S 113TH WEST AVE
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-2724
Country	:	US
Telephone Number	:	918-245-5800
Fax Number	:	918-245-5803

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS BRANDEE MICHELLE SPILLMAN
Credential	:	CPA
Telephone Number	:	918-346-1900

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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