Michael Bennett, DMD
Individual provider Active NPI General Practice Dentistry · Shawnee, OK
NPI 1073258786 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1073258786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 7543 (OK)
- Practice address
- 3703 N Kickapoo Ave
Shawnee, OK 74804-1703 - Phone
- (405) 275-0640
- Fax
- (405) 225-3008
- NPI assigned
- Apr 28, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7543 | OK | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Summer Dental Shawnee PLLC | Current |
Accepting new patients | |
| Summer Dental Midwest City, PLLC | General Practice | Past |
Accepting new patients |
| Tecumseh Family Dentistry PLLC | Past |
Accepting new patients |
Locations
400 Riverwalk Ter
Ste 250
Jenks, OK 74037
3703 N Kickapoo Ave
Shawnee, OK 74804
Phone (405) 275-0640
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7543 | OK | Yes |
Addresses
Primary practice location
3703 N Kickapoo Ave
Shawnee, OK 74804-1703
Mailing address
400 Riverwalk Ter Ste 250
Jenks, OK 74037-5619
Phone (918) 998-0996
Other providers in Shawnee, OK
- Marilyn A. Becker
- Troy Thomas Becker
- Behavioral Medicine Associates, Inc.
- Rachel Beiermann
- Lyric Bell
- Richard Dean Bennett
- Taylor Faith Bennett
- Jordan Benson
- Annette Bentley
- Bethel Public Schools
All providers in Shawnee, OK · General Practice Dentistry in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.