Active NPI
David Alan Ciesla, DDS, MS
- Pediatric Dentistry
- Oklahoma City, OK
National Provider Identifier
1174665111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 7080
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3800 | AR | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Variety Care, Inc. | Current | Accepting new patients | |
| Variety Care, Inc. | Current | 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
- 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.
-
- Federally Qualified Health Center (FQHC)
- Oklahoma City, OK
- NPI 1780697813
-
- Federally Qualified Health Center (FQHC)
- Oklahoma City, OK
- NPI 1942045455
-
- Federally Qualified Health Center (FQHC)
- Oklahoma City, OK
- NPI 1982939526
-
- General Acute Care Hospital
- Oklahoma City, OK
- NPI 1649794157
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.