Organization · NPI-2

A Great Place To Smile

Dentist, General Practice · Tulsa, OK

NPI number1770824781
StatusActive
Last updated in NPPESMar 15, 2013

Details

NPI
1770824781
Entity type
Organization (NPI-2)
Legal business name
A Great Place To Smile
Organization subpart
No
Enumeration date
Mar 15, 2013
Last updated
Mar 15, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice4774OKYes

Practice location

5510 S Memorial Dr
Tulsa, OK 74145-9038

Phone 918-663-9990 · Fax 918-622-9991

Mailing address

5510 S Memorial Dr
Tulsa, OK 74145-9038

Phone 918-663-9990 · Fax 918-622-9991

Authorized official

Marc L Susman
Owner / Doctor
9186838844

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