Organization
SMILE GALAXY PEDIATRIC DENTISTRY
Active
Other names
Smile Zone Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT BRIAN MOLLOY D.D.S. (BUSINESS OWNER)
(405) 692-1222
Entity
Organization
Contact information
Practice address
9801 S. PENNSYLVANIA, OKLAHOMA CITY, OK 73159-6925
(405) 692-1222
(405) 703-0930
Mailing address
PO BOX 892290, OKLAHOMA CITY, OK 73189-2290
(405) 692-1222
(405) 703-0930
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5436
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1390128
UNITED CONCORDIA
—
05
—
200066610A
—
OK
Enumeration date
07/15/2006
Last updated
11/07/2012
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