Provider Demographics
NPI:1689181760
Name:HONOR THY SMILE, PLLC
Entity type:Organization
Organization Name:HONOR THY SMILE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-221-7750
Mailing Address - Street 1:19280 HUNTERS BLUFF TRL
Mailing Address - Street 2:
Mailing Address - City:NEWALLA
Mailing Address - State:OK
Mailing Address - Zip Code:74857-5711
Mailing Address - Country:US
Mailing Address - Phone:877-221-7750
Mailing Address - Fax:877-221-7750
Practice Address - Street 1:2406 E SHAWNEE RD STE D
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1597
Practice Address - Country:US
Practice Address - Phone:918-682-5518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK67671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty