Kickingbird Dental

Primary specialty

DentistTaxonomy code 122300000X

License

OK4913 Issued in OK

Legal business name

KICKINGBIRD DENTAL

Practice address

1333 E Danforth Rd
Edmond, OK 73034-3201

Phone

(405) 359-9696

Fax

(405) 359-0808

NPI assigned

May 27, 2014

Organization subpart

No

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

Authorized official

Name

Ashley Dussault

Title

Office Manager

Phone

(405) 359-9696

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1401148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401148800000",
    "number": "1174935142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 E DANFORTH RD",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730343201",
            "telephone_number": "405-359-9696",
            "fax_number": "405-359-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 E DANFORTH RD",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730343201",
            "telephone_number": "405-359-9696",
            "fax_number": "405-359-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKINGBIRD DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-27",
        "last_updated": "2014-05-27",
        "status": "A",
        "authorized_official_last_name": "DUSSAULT",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-359-9696"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OK",
            "license": "OK4913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kalyn Lee Khalaf, RD
• Mohammad Fazel Khalili, MD
• Viorica Khalili, MD
• Shawn Khavari, M.D.
• Sasan Khodadadian, PHARMD
• Kickingbird Family Medicine PLLC
• Heidi Jane Kidwell, COTA/L
• Katrina Kiefer
• Louis Jay Kieffer, LPC
• Brian Kierl

• Dentist in Edmond, OK
• Providers in Edmond, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2014; 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.