Active NPI
Khem Wood
- General Practice Dentistry
- Braggs, OK
National Provider Identifier
1063429116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4536
- Practice address
- Camp Gruber 100 Highway 10
Braggs, OK 74423 - Phone
- (626) 392-8649
- NPI assigned
- Aug 2, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4536 | OK | Primary |
Addresses
Primary practice location
Camp Gruber 100 Highway 10
Braggs, OK 74423
Mailing address
PO Box 457
Miami, OK 74355-0457
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4536 | OK | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456704000000",
"number": "1063429116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 457",
"city": "MIAMI",
"state": "OK",
"postal_code": "743550457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CAMP GRUBER 100 HIGHWAY 10",
"city": "BRAGGS",
"state": "OK",
"postal_code": "74423",
"telephone_number": "626-392-8649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "KHEM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2016-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "4536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Braggs, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.