WISDOM TOOTH CENTER, PLLC (NPI# 1801303888) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801303888 |
| Entity Type | Organization |
| Organization Name | WISDOM TOOTH CENTER, PLLC |
| Practice Address |
2745 S I 35 Service Rd Moore OK 73160-2715 |
| Practice Telephone | 4052714955 |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2017-12-29 |
| Authorized Official Name | KEVIN S SMITH (PARTNER) |
| Authorized Official Telephone | 4052714955 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| Street Address |
2745 S I 35 SERVICE RD |
| City | MOORE |
| State | OK |
| Zip Code | 73160-2715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225678576 | Crystal Amanda Pitts | Student in an Organized Health Care Education/Training Program | 628 Allison Ln, Moore, OK 73160 | 2020-01-14 |
| 1982247623 | Tammie Lee Haworth | Occupational Therapy Assistant | Quest, 400 N Eastern Ave, Moore, OK 73160 | 2019-10-25 |
| 1477102580 | Php Management Group, LLC | Non-Pharmacy Dispensing Site | 1110 Magnolia Court, Moore, OK 73160 | 2019-09-11 |
| 1477117893 | Pharmology Moore LLC | Pharmacy | 1280 N Eastern Ave, Suite F, Moore, OK 73160 | 2019-05-01 |
| 1154891943 | Leah Cordell | Nurse Practitioner | 1280 North Eastern Ave., Suite F, Moore, OK 73160 | 2018-12-05 |
| 1467962332 | Healthcare Express, LLP | Clinic/Center | 551 Se 4th Street, Moore, OK 73160 | 2017-10-05 |
| 1306379557 | Dicarlo Venegas | Behavior Technician | 716 Wood Hollow Ln, Moore, OK 73160 | 2017-04-05 |
| 1073050167 | Tyron Dorrell Cosby Sr. | Case Manager/Care Coordinator | 1416 Penn Ln., Moore, OK 73160 | 2017-01-26 |
| 1326592650 | Kristin Kelley | Counselor | 1113 S Avery Dr, Moore, OK 73160 | 2016-08-03 |
| 1376912600 | Allison Kay Griffiths | Counselor | 9501 S. I-35 Service Rd, Apt 1504, Moore, OK 73160 | 2015-09-16 |
| Find all providers in zip 73160 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033560966 | Medical Consultant Services | Dentist | 3309 W Princeton St, Broken Arrow, OK 74012-9587 | 2016-06-22 |
| 1487019071 | Stonewood Hills Oral Maxillofacial Surgery, Inc. | Dentist | 425 Stone Wood Dr, Broken Arrow, OK 74012-1026 | 2015-12-23 |
| 1477927085 | Justin Pisano | Dentist | 429 Nw 11th St, Apt 6, Oklahoma City, OK 73103-3927 | 2015-11-19 |
| 1558776989 | Daniel Szalay | Dentist | 1201 N Stonewall Ave Ste 206, Oklahoma City, OK 73117-1214 | 2014-06-24 |
| 1558771170 | Yukon Maxillo-facial Surgery Center | Dentist | 404 S Mustang Rd, Yukon, OK 73099-6754 | 2014-05-05 |
| 1649690025 | Andrew Mcgarry | Dentist | 10900 Hefner Pointe Dr Ste 204, Oklahoma City, OK 73120 | 2014-04-23 |
| 1740572601 | Lauren Lunday | Dentist | 3617 W Gore Blvd Ste B, Lawton, OK 73505-6373 | 2011-05-11 |
| 1265735724 | Michael J. Gliddon Dba Live Oak Oral Surgery | Dentist | 1415 Nw 33rd St, Lawton, OK 73505-3806 | 2010-12-06 |
| 1023329901 | Armando Retana | Dentist | 7322 E 91st St, Tulsa, OK 74133-6016 | 2010-06-25 |
| 1316275951 | Brooks Surgical Arts, Pllc | Dentist | 3441 W Rock Creek Rd, Norman, OK 73072-2435 | 2009-11-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.