Individual provider Active NPI

Jerry D McCan X, DDS

  • General Practice Dentistry
  • Tuttle, OK
National Provider Identifier
1003843103
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4124 Issued in OK
Practice address
7 Cedar Springs Dr
Tuttle, OK 73089-7929
Phone
(405) 381-2303
NPI assigned
Jun 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4124 OK Primary

Addresses

Primary practice location

7 Cedar Springs Dr
Tuttle, OK 73089-7929

Mailing address

7 Cedar Springs Dr
Tuttle, OK 73089-7929
Phone (405) 381-2303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150608000808 OK Order and Referring Only - DentistPractitioner - Dentist 9931420569

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Jerry D McCan DDS General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003843103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 CEDAR SPRINGS DR",
            "city": "TUTTLE",
            "state": "OK",
            "postal_code": "730897929",
            "telephone_number": "405-381-2303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 CEDAR SPRINGS DR",
            "city": "TUTTLE",
            "state": "OK",
            "postal_code": "730897929",
            "telephone_number": "405-381-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCAN",
        "first_name": "JERRY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "name_suffix": "X",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuttle, OK

Sources for this page

Verify at the official NPI Registry.