Jonathan Chu-Ming Soetandio, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

37917 Issued in TX

Practice address

5510 E 41St St Ste C
Tulsa, OK 74135-6009

Phone

(918) 641-4635

NPI assigned

Sep 3, 2020

Last updated

Dec 14, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Alexander D. Williams, D.D.S., P.C.

  dba Aspen Dental

  • General Practice Dentistry
  • Tulsa, OK
  • NPI 1033571104
  NPD (past)

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1093329260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 S LOOP 336 W",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5510 E 41ST ST STE C",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356009",
            "telephone_number": "918-641-4635"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 S Loop 336 W",
            "address_purpose": "LOCATION",
            "city": "Conroe",
            "state": "TX",
            "postal_code": "773043305",
            "country_code": "US",
            "telephone_number": "936-270-1294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOETANDIO",
        "first_name": "JONATHAN",
        "middle_name": "CHU-MING",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-03",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "7387",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "37917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Holly Marie Soho
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• Hazem Sokkar, M.D.
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• Lauren Nicole Sokolosky, LMSW U/S

• General Practice Dentistry in Tulsa, OK
• Providers in Tulsa, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; 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.