Individual provider Active NPI

Paul Mathews Mullasseril, DDS

  • Prosthodontics
  • Oklahoma City, OK
National Provider Identifier
1164585519
Registry record updated Aug 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
5360 Issued in OK
Practice address
1201 N Stonewall Ave
Oklahoma City, OK 73117-1214
Phone
(405) 271-5714
Fax
(405) 271-2405
NPI assigned
Dec 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 5360 OK Primary

Addresses

Primary practice location

1201 N Stonewall Ave
Oklahoma City, OK 73117-1214

Mailing address

PO Box 26901
DCS 209
Oklahoma City, OK 73190-0001
Phone (405) 271-5714

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090421000484 OK Practitioner - Oral Surgery 0749337293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral Surgery
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1201 N Stonewall Ave
Oklahoma City, OK 73117-1214
Phone (405) 271-5714

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5360OKMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Board of Regents of the University of Oklahoma - Ou Denitstry CurrentSince Nov 15, 2006 Accepting new patients
University Oral & Maxillo Facial Surgeons Past Accepting new patients

Locations

1201 N Stonewall Ave
Oklahoma City, OK 73117
Phone (405) 271-5714

1201 N Stonewall Ave
Rm 321
Oklahoma City, OK 73117

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219968000000",
    "number": "1164585519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26901",
            "address_2": "DCS 209",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731900001",
            "telephone_number": "405-271-5714",
            "fax_number": "405-271-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N STONEWALL AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731171214",
            "telephone_number": "405-271-5714",
            "fax_number": "405-271-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLASSERIL",
        "first_name": "PAUL",
        "middle_name": "MATHEWS",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2008-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "OK",
            "license": "5360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.