Antony Okinyi Odhiambo, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

24621 Issued in TX

Practice address

5605 Old Bullard Rd
Tyler, TX 75703-4306

Phone

(903) 747-3919

Fax

(903) 747-3923

NPI assigned

Jun 12, 2009

Last updated

Nov 5, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alpha First Dental Clinic P.a

  dba Kindle Dental

  • General Practice Dentistry
  • Marshall, TX
  • NPI 1699403584
  NPD (past)
• Alpha First Dental Clinic P.a

  dba Kindle Dental

  • General Practice Dentistry
  • Longview, TX
  • NPI 1720269707
  NPD (past)

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

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478304000000",
    "number": "1073740478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 E MARSHALL AVE",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756016814",
            "telephone_number": "903-242-9777",
            "fax_number": "903-212-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5605 OLD BULLARD RD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034306",
            "telephone_number": "903-747-3919",
            "fax_number": "903-747-3923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODHIAMBO",
        "first_name": "ANTONY",
        "middle_name": "OKINYI",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-12",
        "last_updated": "2016-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "24621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Occupational Health Centers of the Southwest P.a. (Concentra Medical Centers)
• Occupational Health Centers of the Southwest P.a. (Concentra Medical Centers)
• Dialezmy Ochoa
• Pamella Ochoa, PHARM.D.
• Jerrod Ryan Odette, DDS
• Janice Oeffner
• Kimmery Lanell Offord
• Evans Ofosu
• Lynette M Ogletree, DDS
• Stephen Ryan Ogletree, MD

• General Practice Dentistry in Tyler, TX
• Providers in Tyler, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2016; 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.

Verify at the official NPI Registry.