Individual
MARK DAVID SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1205 E ROSS BYPASS, TAHLEQUAH, OK 74464
(918) 456-2555
(918) 456-2444
Mailing address
1205 E ROSS BYPASS, TAHLEQUAH, OK 74464
(918) 456-2555
(918) 456-2444
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5389
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20020390
—
OK
Enumeration date
03/09/2006
Last updated
07/13/2026
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