NPIMap

Organization Active NPI

Dental Group PC

  • General Practice Dentistry
  • Pryor, OK
National Provider Identifier
1043480924
Registry record updated Mar 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4382 Issued in OK
Legal business name
DENTAL GROUP PC
Practice address
109 N Fairland St
Ste 110
Pryor, OK 74361-4203
Phone
(918) 825-7411
Fax
(918) 825-7734
NPI assigned
Mar 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2008

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

Authorized official

Name
Freda Jane Anderson
Title
Office Manager
Phone
(918) 825-7411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 4382 OK Primary

Addresses

Primary practice location

109 N Fairland St
Ste 110
Pryor, OK 74361-4203

Mailing address

PO Box 649
Pryor, OK 74362-0649
Phone (918) 825-7411

National Provider Directory

National Provider Directory

Locations

109 N Fairland St
Ste 110
Pryor, OK 74361
Phone (918) 825-7411

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1043480924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743620649",
            "telephone_number": "918-825-7411",
            "fax_number": "918-825-7734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 N FAIRLAND ST",
            "address_2": "STE 110",
            "city": "PRYOR",
            "state": "OK",
            "postal_code": "743614203",
            "telephone_number": "918-825-7411",
            "fax_number": "918-825-7734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "FREDA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-825-7411"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pryor, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.