MEDICARE: SMILING FACES MWC PLLC

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
2	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1689521676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMILING FACES MWC PLLC

Provider Business Mailing Address
First Line	:	1152 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1152 S DOUGLAS BLVD
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5237
Country	:	US
Telephone Number	:	405-947-1525
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER RELATIONS
Name	:	MR. GAYLON ZISSA
Credential	:
Telephone Number	:	405-945-8941

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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