Shanon Black, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7631 Issued in OK

Practice address

316 N Main St Ste 1
Stillwater, OK 74075-5548

Phone

(405) 372-7474

NPI assigned

Jul 6, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stillwater Dentistry & Braces

  • Dental Clinic/Center
  • Stillwater, OK
  • NPI 1962924100
  NPD

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1003549122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 S DUNCAN ST",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744427",
            "telephone_number": "785-766-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 N MAIN ST STE 1",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740755548",
            "telephone_number": "405-372-7474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "SHANON",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "7631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://stillwaterdds.com/",
            "affiliation": "Y",
            "endpointDescription": "https://stillwaterdds.com/",
            "affiliationName": "Stillwater Dentistry & Braces",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "316 N Main St Ste 1",
            "city": "Stillwater",
            "state": "OK",
            "country_code": "US",
            "postal_code": "740755548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bison Behavioral
• Bison Counseling
• Jessica Nicole Bittner
• Laura Black, M.A., LPC CANDIDATE
• Lindsay Black
• Tayah Marie Black, RBT
• John Blair, APRN
• Rachel Amariah Blair
• Scott William Blair
• Amanda Lynne Blalock, BA

• General Practice Dentistry in Stillwater, OK
• Providers in Stillwater, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; 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.