Provider Demographics
NPI:1124309216
Name:SMILING MONKEY PLLC
Entity type:Organization
Organization Name:SMILING MONKEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:ISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-224-7000
Mailing Address - Street 1:1044 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4505
Mailing Address - Country:US
Mailing Address - Phone:918-224-7000
Mailing Address - Fax:
Practice Address - Street 1:1044 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4505
Practice Address - Country:US
Practice Address - Phone:918-224-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK59951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200349370AMedicaid