Kipley Powell, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7889 Issued in OK

Practice address

4716 W Urbana St Ste 100
Broken Arrow, OK 74012-6162

Phone

(918) 449-5800

Fax

(918) 449-5800

NPI assigned

Jun 4, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 30, 2024 through May 30, 2028

Medicare enrollment (NPD)

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.

• Eastern Oklahoma Oral and Maxillofacial Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Broken Arrow, OK
  • NPI 1487074704
  NPD (past)

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1205450319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4716 W URBANA ST STE 100",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126162",
            "telephone_number": "918-449-5800",
            "fax_number": "918-449-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4716 W URBANA ST STE 100",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740126162",
            "telephone_number": "918-449-5800",
            "fax_number": "918-449-5800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12802 E 101st Pl N",
            "address_purpose": "LOCATION",
            "city": "Owasso",
            "state": "OK",
            "postal_code": "740554662",
            "country_code": "US",
            "telephone_number": "918-449-5800",
            "fax_number": "918-455-8958",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1331 S York St",
            "address_purpose": "LOCATION",
            "city": "Muskogee",
            "state": "OK",
            "postal_code": "744037672",
            "country_code": "US",
            "telephone_number": "918-449-5800",
            "fax_number": "918-455-8958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POWELL",
        "first_name": "KIPLEY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-04",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "7889",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OK",
            "license": "246",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashlee Potter
• Wade Bailey Potter
• Rebecca Povlock
• Ibrianna Powell
• Kaylee Powell
• James Alan Prather Jr., MS
• Satrina Pratt
• Precision Optical of Okla Inc (Precision Optical)
• Preferred Physical Therapy Broken Arrow, PLLC
• Premier Family Care PC

• Oral and Maxillofacial Surgery (Dentist) in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.