Premiere Family Dentistry of Tahlequah, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

PREMIERE FAMILY DENTISTRY OF TAHLEQUAH, PLLC

Practice address

1205 E Ross Byp
Tahlequah, OK 74464-4188

Phone

(918) 456-2555

Fax

(918) 456-2444

NPI assigned

Nov 16, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Smith, DDSNPI 1124096755

Title

Senior Manager

Phone

(918) 456-2555

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark David Smith, DDS

  • General Practice Dentistry
  • Tahlequah, OK
  • NPI 1124096755
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1780340513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 E ROSS BYP",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744644188",
            "telephone_number": "918-456-2555",
            "fax_number": "918-456-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 E ROSS BYP",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744644188",
            "telephone_number": "918-456-2555",
            "fax_number": "918-456-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERE FAMILY DENTISTRY OF TAHLEQUAH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-16",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SENIOR MANAGER",
        "authorized_official_telephone_number": "918-456-2555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Ray Potts, D. PH.
• Gena Powers
• Charles Pradieu, M.D.
• Premiere Dentistry of Tahlequah
• Premiere Dentistry of Tahlequah, P.C.
• Jesse Lee Price, LCSW
• Prime Medical Outlet LLC
• Billi Jayne Prinzen, O.D.
• Alissa Proctor, OD
• Prodigy Foundation

• Dental Clinic/Center in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Dental Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.