Provider Demographics
NPI:1528373867
Name:ABSOLUTE SMILES FAMILY DENTISTRY
Entity type:Organization
Organization Name:ABSOLUTE SMILES FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-381-0900
Mailing Address - Street 1:4800 E. HWY. 37
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089
Mailing Address - Country:US
Mailing Address - Phone:405-381-0900
Mailing Address - Fax:
Practice Address - Street 1:4800 E. HWY. 37
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089
Practice Address - Country:US
Practice Address - Phone:405-381-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5944302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization