Shattuck Dentistry & Braces

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SHATTUCK DENTISTRY & BRACES

Practice address

1523 S Main St
Shattuck, OK 73858-9223

Phone

(580) 938-2566

Fax

(580) 938-2567

NPI assigned

Jul 10, 2017

Last updated

Oct 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin James Bowman, DDS

Title

Manager

Phone

(405) 326-8004

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1499644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603929600000",
    "number": "1114449394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 S. MAIN",
            "city": "SHATTUCK",
            "state": "OK",
            "postal_code": "73858",
            "telephone_number": "580-938-2566",
            "fax_number": "580-938-2567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 S MAIN ST",
            "city": "SHATTUCK",
            "state": "OK",
            "postal_code": "738589223",
            "telephone_number": "580-938-2566",
            "fax_number": "580-938-2567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHATTUCK DENTISTRY & BRACES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-10",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "405-326-8004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1205032935",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Newman Memorial Hospital, Inc.
• Newman Physicians' Group, Inc.
• Lisa Marie Oakley
• Jerson Penaflor
• Scott Eye Care P L L C (Northwest Eye Associates)
• Shattuck Nursing Center Inc
• Shattuck Pharmacy Management Inc (Medic Pharmacy & Gifts)
• Shattuck Public Schools
• Stuart Family Medicine, PLLC
• Stuart Family Medicine, PLLC. (Newman Healthcare Associates)

• Dentist in Shattuck, OK
• Providers in Shattuck, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.