NPIMap

Organization Active NPI

Fort Gibson Family Dentistry PC

  • General Practice Dentistry
  • Fort Gibson, OK
National Provider Identifier
1114052032
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FORT GIBSON FAMILY DENTISTRY PC
Practice address
801 S Lee St
Suite a
Fort Gibson, OK 74434-8710
Phone
(918) 478-4433
Fax
(918) 478-4066
NPI assigned
Feb 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Michael John Nelson, DDSNPI 1235271578
Title
Owner
Phone
(918) 478-4433

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

801 S Lee St
Suite a
Fort Gibson, OK 74434-8710

Mailing address

801 S Lee St.
Suite a
Fort Gibson, OK 74434
Phone (918) 478-4433

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114052032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S LEE ST.",
            "address_2": "SUITE A",
            "city": "FORT GIBSON",
            "state": "OK",
            "postal_code": "74434",
            "telephone_number": "918-478-4433",
            "fax_number": "918-478-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S LEE ST",
            "address_2": "SUITE A",
            "city": "FORT GIBSON",
            "state": "OK",
            "postal_code": "744348710",
            "telephone_number": "918-478-4433",
            "fax_number": "918-478-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT GIBSON FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-478-4433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Gibson, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.