Provider Demographics
NPI:1285960526
Name:SMILE CONCEPTS PC
Entity type:Organization
Organization Name:SMILE CONCEPTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:918-742-4500
Mailing Address - Street 1:3150 E 41ST ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3717
Mailing Address - Country:US
Mailing Address - Phone:918-742-4500
Mailing Address - Fax:918-742-4515
Practice Address - Street 1:3150 E 41ST ST
Practice Address - Street 2:SUITE 108
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3717
Practice Address - Country:US
Practice Address - Phone:918-742-4500
Practice Address - Fax:918-742-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty