Provider Demographics
NPI:1215118096
Name:ALL SMILES DENTAL & DENTURE CLINIC, PC
Entity type:Organization
Organization Name:ALL SMILES DENTAL & DENTURE CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-443-9900
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053-0639
Mailing Address - Country:US
Mailing Address - Phone:918-443-9900
Mailing Address - Fax:918-443-9911
Practice Address - Street 1:225 N HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:OOLOGAH
Practice Address - State:OK
Practice Address - Zip Code:74053-6364
Practice Address - Country:US
Practice Address - Phone:918-443-9900
Practice Address - Fax:918-443-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK52781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty