Active NPI
Leslie Anne Tevebaugh, D.D.S.
- General Practice Dentistry
- Woodward, OK
National Provider Identifier
1093741704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5440
- Practice address
- 1722 Main Street
Woodward, OK 73801 - Phone
- (580) 256-6816
- Fax
- (580) 256-9839
- NPI assigned
- Jun 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 5440 | OK | Primary |
Addresses
Primary practice location
1722 Main Street
Woodward, OK 73801
Mailing address
1722 Main Street
Woodward, OK 73801
Phone (580) 256-6816
Other names 1
- Leslie Anne Pruett
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 |
|---|---|---|---|
| 5440 | OK | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1296604800000",
"number": "1093741704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1722 MAIN STREET",
"city": "WOODWARD",
"state": "OK",
"postal_code": "73801",
"telephone_number": "580-256-6816",
"fax_number": "580-256-9839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1722 MAIN STREET",
"city": "WOODWARD",
"state": "OK",
"postal_code": "73801",
"telephone_number": "580-256-6816",
"fax_number": "580-256-9839"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEVEBAUGH",
"first_name": "LESLIE",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-24",
"last_updated": "2011-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "5440",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LESLIE",
"last_name": "PRUETT",
"middle_name": "ANNE",
"credential": "D.D.S.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Woodward, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.