NPIMap

Organization Active NPI

On the Cusp Pediatric Dentistry, PLLC

  • Pediatric Dentistry
  • Tulsa, OK
National Provider Identifier
1114287091
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ON THE CUSP PEDIATRIC DENTISTRY, PLLC
Practice address
8222 E 103Rd St Ste 133
Tulsa, OK 74133-7027
Phone
(918) 970-4944
Fax
(918) 970-4593
NPI assigned
May 24, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Authorized official

Name
Dr. Ryan Roberts, D.D.S., M.S.NPI 1205097946
Title
Owner/Member
Phone
(918) 970-4944

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

8222 E 103Rd St Ste 133
Tulsa, OK 74133-7027

Mailing address

8222 E 103Rd St
133
Tulsa, OK 74133-7081
Phone (918) 970-4944

Other identifiers 1

IdentifierTypeStateIssuer
200258530AMedicaidOK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1337817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1114287091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8222 E 103RD ST",
            "address_2": "133",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741337081",
            "telephone_number": "918-970-4944",
            "fax_number": "918-970-4593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8222 E 103RD ST STE 133",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741337027",
            "telephone_number": "918-970-4944",
            "fax_number": "918-970-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ON THE CUSP PEDIATRIC DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-24",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "918-970-4944",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200258530A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.