Custom Dental of Yukon, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CUSTOM DENTAL OF YUKON, PLLC

Practice address

4425 Grant Blvd
Yukon, OK 73099

Phone

(405) 494-4856

Fax

(405) 494-4184

NPI assigned

Jun 26, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Katelyn Johnson, DDS

Title

Owner-Doctor

Phone

(918) 839-9088

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

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

• Katelyn Mack, DMD

  • Dentist
  • Yukon, OK
  • NPI 1750764031
  NPD

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593129600000",
    "number": "1164049185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 GRANT BLVD",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-494-4856",
            "fax_number": "405-494-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 GRANT BLVD",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-494-4856",
            "fax_number": "405-494-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM DENTAL OF YUKON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-26",
        "last_updated": "2020-06-26",
        "certification_date": "2020-06-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KATELYN",
        "authorized_official_title_or_position": "OWNER-DOCTOR",
        "authorized_official_telephone_number": "918-839-9088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "yukon@customdentalusa.com",
            "affiliation": "N",
            "endpointDescription": "dental",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "dental",
            "address_1": "4425 Grant Blvd",
            "city": "Yukon",
            "state": "OK",
            "country_code": "US",
            "postal_code": "73099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jeanette Cruz
• Jason Shahid Cuff Sr.
• Avery Curd
• Curtis E. Roberson,OD Inc
• Natalie Gail Curtis
• Cutting Edge Physical Therapy PLLC
• Jaelynn Czajkowski
• Damon L Johnson, DDS, PC
• Bansi Daniel
• Callie Daun Daniel

• Dental Clinic/Center in Yukon, OK
• Providers in Yukon, OK by specialty
• Dental Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.