Okc 89TH Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

OKC 89TH DENTAL, PLLC

Doing business as

Summer Dental OKC

Practice address

7801 S Western Ave Ste 101
Oklahoma City, OK 73139-2411

Phone

(405) 691-3399

Fax

(405) 256-1191

NPI assigned

Nov 21, 2016

Last updated

Aug 12, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Creed Louis Cardon, DDS

Title

Owner

Phone

(918) 998-0996

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Summer Dental OKC Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adrianne Nicole Brathwaite, DDS

  • Dentist
  • Oklahoma City, OK
  • NPI 1306682356
  NPD (past)
• Colby Troy Broadbent, DDS

  • General Practice Dentistry
  • Oklahoma City, OK
  • NPI 1558882548
  NPD (past)
• Thanh Huu Truong, DDS

  • General Practice Dentistry
  • Yukon, OK
  • NPI 1184368722
  NPD (past)

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1215470497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERWALK TER STE 250",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740375619",
            "telephone_number": "918-998-0996",
            "fax_number": "918-235-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7801 S WESTERN AVE STE 101",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731392411",
            "telephone_number": "405-691-3399",
            "fax_number": "405-256-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKC 89TH DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-21",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "CARDON",
        "authorized_official_first_name": "CREED",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-998-0996",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200679550A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summer Dental OKC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Oklahoma City, OK
• Providers in Oklahoma City, 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 Aug 12, 2020; 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.