Provider Demographics
NPI:1457737330
Name:AMAZING SMILES
Entity type:Organization
Organization Name:AMAZING SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-360-2404
Mailing Address - Street 1:224 W GRAY ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7115
Mailing Address - Country:US
Mailing Address - Phone:405-360-2404
Mailing Address - Fax:405-360-3414
Practice Address - Street 1:224 W GRAY ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7115
Practice Address - Country:US
Practice Address - Phone:405-360-2404
Practice Address - Fax:405-360-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK60231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty