MEDICARE: CLEVELAND SMILES 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

General Provider Information

NPI Number	:	1942431655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND SMILES PLLC

Provider Business Mailing Address
First Line	:	1390 W CHEROKEE ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4044
Country	:	US
Telephone Number	:	918-358-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1390 W CHEROKEE ST
Second Line	:
City	:	CLEVELAND
State	:	OK
Zip	:	74020-4044
Country	:	US
Telephone Number	:	918-358-2300
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. MARK MERIDETH
Credential	:
Telephone Number	:	405-471-5225

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	07/29/2009

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