# PREMIERE FAMILY DENTISTRY OF TAHLEQUAH, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780340513
- **Authorized official:** DR. MARK SMITH DDS (SENIOR MANAGER)
- **Authorized official phone:** (918) 456-2555

## Contact information

- **Practice address:** 1205 E ROSS BYP, TAHLEQUAH, OK 74464-4188
- **Practice address phone:** (918) 456-2555
- **Practice address fax:** (918) 456-2444
- **Mailing address:** 1205 E ROSS BYP, TAHLEQUAH, OK 74464-4188
- **Mailing address phone:** (918) 456-2555
- **Mailing address fax:** (918) 456-2444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/16/2021
- **Last updated:** 11/16/2021