NPIMap

Organization Active NPI

Jay W. Pettit DDS Inc.

  • General Practice Dentistry
  • Bristow, OK
National Provider Identifier
1164585097
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4885 Issued in OK
Legal business name
JAY W. PETTIT DDS INC.
Practice address
112 N Elm St
Bristow, OK 74010-2424
Phone
(918) 367-5900
Fax
(918) 367-3226
NPI assigned
Dec 19, 2006
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. Jay Wade Pettit, D.D.S.NPI 1154527265
Title
President
Phone
(918) 367-5900

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 4885 OK Primary

Addresses

Primary practice location

112 N Elm St
Bristow, OK 74010-2424

Mailing address

112 N Elm St
Bristow, OK 74010-2424
Phone (918) 367-5900

Other identifiers 1

IdentifierTypeStateIssuer
1304885MedicaidOK

National Provider Directory

National Provider Directory

Locations

112 N Elm St
Bristow, OK 74010
Phone (918) 367-5900

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": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164585097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N ELM ST",
            "city": "BRISTOW",
            "state": "OK",
            "postal_code": "740102424",
            "telephone_number": "918-367-5900",
            "fax_number": "918-367-3226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N ELM ST",
            "city": "BRISTOW",
            "state": "OK",
            "postal_code": "740102424",
            "telephone_number": "918-367-5900",
            "fax_number": "918-367-3226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAY W. PETTIT DDS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-367-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1304885",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristow, 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.