Provider Demographics
NPI:1104272913
Name:HEALTHY SMILES FAMILY DENTISTRY PLLP
Entity type:Organization
Organization Name:HEALTHY SMILES FAMILY DENTISTRY PLLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-749-0303
Mailing Address - Street 1:1326 E 43RD CT
Mailing Address - Street 2:STE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4154
Mailing Address - Country:US
Mailing Address - Phone:918-749-0303
Mailing Address - Fax:
Practice Address - Street 1:1326 E 43RD CT STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-4155
Practice Address - Country:US
Practice Address - Phone:918-749-0303
Practice Address - Fax:918-749-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
OK5123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7550710001Medicare NSC