Individual provider Active NPI

David Alan Ciesla, DDS, MS

  • Pediatric Dentistry
  • Oklahoma City, OK
National Provider Identifier
1174665111
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
7080 Issued in OK
Practice address
1201 N Stonewall Ave
Oklahoma City, OK 73117-1214
Phone
(405) 271-6056
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 12145 TX
Pediatric Dentistry 1223P0221X 7080 OK Primary
Pediatric Dentistry 1223P0221X 3800 AR

Addresses

Primary practice location

1201 N Stonewall Ave
Oklahoma City, OK 73117-1214

Mailing address

1201 N Stonewall Ave
Oklahoma City, OK 73117-1214
Phone (479) 926-0585

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
I20220629001295 OK Practitioner - Dentist 6709266331 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
3800ARMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Variety Care, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Variety Care, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Variety Care, Inc. Current Accepting new patients
Ou Medicine Inc. Past Accepting new patients

Locations

3000 N Grand Blvd
Oklahoma City, OK 73107
Phone 405632668810209

1025 Straka Ter
Oklahoma City, OK 73139
Phone (405) 629-5281

Interoperability endpoints

  • Direct secure messaging: dciesla782290@ahs.direct-ci.com

Organizations & group practices 4

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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1174665111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 N STONEWALL AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731171214",
            "telephone_number": "479-926-0585"
        },
        {
            "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": "405-271-6056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIESLA",
        "first_name": "DAVID",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "12145",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OK",
            "license": "7080",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "3800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.