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NPI Code Detail

MEDICARE: KOOL SMILES OK, PC

MEDICARE: KOOL SMILES OK, 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
11223E0200XEndodontics
21223S0112XOral and Maxillofacial Surgery (Dentist)
31223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1639494149
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOOL SMILES OK, PC
Provider Business Mailing Address
First Line : 1090 NORTHCHASE PKWY SE STE 150
Second Line :
City : MARIETTA
State : GA
Zip : 30067-6407
Country : US
Telephone Number : 770-916-5028
Fax Number : 678-247-7858
Provider Business Practice Location Address
First Line : 1200 S AIR DEPOT BLVD
Second Line :
City : MIDWEST CITY
State : OK
Zip : 73110-4866
Country : US
Telephone Number : 800-920-9947
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. DALE G MAYFIELD
Credential : DDS
Telephone Number : 770-916-5036
Provider Enumeration Date : 03/29/2010
Last Update Date : 12/19/2018

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Directions to “KOOL SMILES OK, PC ” Practice Location

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