NPIMap

Organization Active NPI

Hero Dental of Oklahoma PC

  • General Practice Dentistry
  • Tulsa, OK
National Provider Identifier
1053875690
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
HERO DENTAL OF OKLAHOMA PC
Doing business as
Pediatric Dental Group II, LLC
Practice address
7715 E 91St St Ste a
Tulsa, OK 74133-6060
Phone
(918) 872-7009
NPI assigned
Jan 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Authorized official

Name
Charlotte Souder
Title
Credentialing Manager
Phone
(719) 649-0305

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

7715 E 91St St Ste a
Tulsa, OK 74133-6060

Mailing address

2221 E Bijou St Ste 100
Colorado Springs, CO 80909-8009
Phone (719) 576-1850

Other names 1

  • Pediatric Dental Group II, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hero Dental of Oklahoma PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1548633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1053875690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 E BIJOU ST STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098009",
            "telephone_number": "719-576-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7715 E 91ST ST STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741336060",
            "telephone_number": "918-872-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERO DENTAL OF OKLAHOMA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-28",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "SOUDER",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "719-649-0305"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dental Group II, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 28, 2019; 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.