Active NPI
Christian Shaun Mirabal, DDS
- Dentist
- Tulsa, OK
National Provider Identifier
1023484284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6682
- Practice address
- 3150 E 41St St Ste 131
Tulsa, OK 74105-3758 - Phone
- (918) 749-1639
- Fax
- (918) 749-0416
- NPI assigned
- Aug 11, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6682 | OK | Primary |
Addresses
Primary practice location
3150 E 41St St Ste 131
Tulsa, OK 74105-3758
Mailing address
3150 E 41St St Ste 131
Tulsa, OK 74105-3758
Phone (918) 749-1639
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160407000019 | OK | Order and Referring Only - Dentist | 1456659432 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6682 | OK | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537747200000",
"number": "1023484284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3150 E 41ST ST STE 131",
"city": "TULSA",
"state": "OK",
"postal_code": "741053758",
"telephone_number": "918-749-1639",
"fax_number": "918-749-0416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 E 41ST ST STE 131",
"city": "TULSA",
"state": "OK",
"postal_code": "741053758",
"telephone_number": "918-749-1639",
"fax_number": "918-749-0416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRABAL",
"first_name": "CHRISTIAN",
"middle_name": "SHAUN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-11",
"last_updated": "2018-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "6682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.