Kellie Sue Ophus, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6292 Issued in OK

Practice address

19 W Interstate Pkwy
Shawnee, OK 74804-1331

Phone

(405) 275-0675

NPI assigned

Jun 21, 2011

Last updated

Jun 21, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Okc Dental Health Associates, P.C.

  dba MyDentist-Shawnee

  • General Practice Dentistry
  • Shawnee, OK
  • NPI 1154741007
  NPD (past)

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

{
    "created_epoch": "1308614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1174819841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 N CHARLES AVE",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731303411",
            "telephone_number": "405-830-6437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 W INTERSTATE PKWY",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041331",
            "telephone_number": "405-275-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OPHUS",
        "first_name": "KELLIE",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-21",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oklahoma Speech Consultants, PLLC (Latitude Learning and Therapy Institute)
• Oklahoma Spine Diagnostic and Pain Treatment Center PLLC
• Oklahoma Sports and Orthopedics Institute PLLC
• Leanna Rae Olsen, R.N., C.M.T.
• Eric Olson
• Opshaw, LLC (Rose Manor)
• Optical Galleria
• Orthodontic Specialists of Shawnee
• Jose A Ortiz
• Jennifer Dawn Osife

• General Practice Dentistry in Shawnee, OK
• Providers in Shawnee, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; 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.