Provider Demographics
NPI:1174202881
Name:SMILE STUDIO - STILLWATER, PLLC
Entity type:Organization
Organization Name:SMILE STUDIO - STILLWATER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARROZ
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-819-4701
Mailing Address - Street 1:1522 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4372
Mailing Address - Country:US
Mailing Address - Phone:405-372-8300
Mailing Address - Fax:
Practice Address - Street 1:1522 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4372
Practice Address - Country:US
Practice Address - Phone:405-372-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty