Provider Demographics
NPI:1285809723
Name:ELITE SMILES
Entity type:Organization
Organization Name:ELITE SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:SANOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-418-4999
Mailing Address - Street 1:5701 N WESTERN AVE STE E
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1236
Mailing Address - Country:US
Mailing Address - Phone:405-418-4999
Mailing Address - Fax:405-286-9725
Practice Address - Street 1:5701 N WESTERN AVE STE E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1236
Practice Address - Country:US
Practice Address - Phone:405-418-4999
Practice Address - Fax:405-286-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5782261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental