Organization
BROADWAY SMILES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER RYAN BUGG DDS (OWNER)
(918) 285-5500
Entity
Organization
Contact information
Practice address
601 E BROADWAY ST, CUSHING, OK 74023-3432
(918) 285-5500
(918) 285-5502
Mailing address
601 E BROADWAY ST, CUSHING, OK 74023-3432
(918) 285-5500
(918) 285-5502
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5628
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100845810A
—
OK
Enumeration date
04/22/2008
Last updated
04/22/2008
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