1205935368 NPI number — LORI SMITH DDS INC PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205935368 NPI number — LORI SMITH DDS INC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORI SMITH DDS INC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205935368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 SOUTH COOYYAH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRYOR
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-825-7645
Provider Business Mailing Address Fax Number:
918-825-7646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 SOUTH COOYYAH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRYOR
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-825-7645
Provider Business Practice Location Address Fax Number:
918-825-7646
Provider Enumeration Date:
09/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
LORI
Authorized Official Middle Name:
TRIEBEL
Authorized Official Title or Position:
OWNER PRESIDENT DENTIST
Authorized Official Telephone Number:
918-825-7645

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5334 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100150130A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 455716222001 . This is a "BLUE CROSS SHIELD OF OK" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".