Organization
PREMIERE FAMILY DENTISTRY OF TAHLEQUAH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK SMITH DDS (SENIOR MANAGER)
(918) 456-2555
Entity
Organization
Contact information
Practice address
1205 E ROSS BYP, TAHLEQUAH, OK 74464-4188
(918) 456-2555
(918) 456-2444
Mailing address
1205 E ROSS BYP, TAHLEQUAH, OK 74464-4188
(918) 456-2555
(918) 456-2444
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/16/2021
Last updated
11/16/2021
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