NPIMap

Organization Active NPI

Dental Square LLC

Doing business as Dental Square

  • General Practice Dentistry
  • Bethany, OK
National Provider Identifier
1164979076
Registry record updated Sep 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6727 Issued in OK
Legal business name
DENTAL SQUARE LLC
Doing business as
Dental Square
Practice address
6301 NW 23Rd St
Bethany, OK 73008-5931
Phone
(405) 495-2402
Fax
(405) 495-1325
NPI assigned
Sep 8, 2016
Last updated
Sep 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2016

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

Authorized official

Name
Anusha Koneru, DDS
Title
Ceo
Phone
(405) 495-2402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6727 OK Primary

Addresses

Primary practice location

6301 NW 23Rd St
Bethany, OK 73008-5931

Mailing address

6301 NW 23Rd St
Bethany, OK 73008-5931
Phone (405) 495-2402

Other names 1

  • Dental Square Doing business as

National Provider Directory

National Provider Directory

Locations

6301 NW 23rd St
Bethany, OK 73008
Phone (405) 474-6362

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1473292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473292800000",
    "number": "1164979076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6301 NW 23RD ST",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730085931",
            "telephone_number": "405-495-2402",
            "fax_number": "405-495-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 NW 23RD ST",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730085931",
            "telephone_number": "405-495-2402",
            "fax_number": "405-495-1325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL SQUARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-08",
        "last_updated": "2016-09-08",
        "status": "A",
        "authorized_official_last_name": "KONERU",
        "authorized_official_first_name": "ANUSHA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-495-2402",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Square",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethany, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; 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.