Nova Oral Surgery LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

NOVA ORAL SURGERY LLC

Doing business as

Southeast Oklahoma Oral and Maxillofacial

Practice address

803 N Monte Vista St
Ada, OK 74820-7711

Phone

(580) 332-3010

Fax

(580) 332-3010

NPI assigned

Nov 23, 2022

Organization subpart

No

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

Authorized official

Name

Hans Charles Igou, DDSNPI 1255778668

Title

Owner

Phone

(580) 332-3010

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southeast Oklahoma Oral and Maxillofacial Doing business as

Locations

Practitioners 1

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.

• Hans Charles Igou, D.D.S.

  • Dentist
  • Ada, OK
  • NPI 1255778668

  Oral and Maxillofacial Surgery

  NPD Authorized official

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

{
    "created_epoch": "1669161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1225747736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748207711",
            "telephone_number": "580-332-3010",
            "fax_number": "580-332-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748207711",
            "telephone_number": "580-332-3010",
            "fax_number": "580-332-3010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1609 N Strong Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "McAlester",
            "state": "OK",
            "postal_code": "745013881",
            "country_code": "US",
            "telephone_number": "918-426-3244",
            "fax_number": "918-426-3254",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 S Mustang Rd",
            "address_purpose": "LOCATION",
            "city": "Yukon",
            "state": "OK",
            "postal_code": "730996777",
            "country_code": "US",
            "telephone_number": "405-494-7227",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NOVA ORAL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-23",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "IGOU",
        "authorized_official_first_name": "HANS",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-332-3010",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200485650A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Oklahoma Oral and Maxillofacial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mona Jean Nickerson, APRN, FNP-C
• Jack Ryan Norgren, DO
• Timothy E Norris
• Jordan Northam
• Aubrie Morgan Northcutt, DO
• Nra Ada Oklahoma LLC (Ada Dialysis Center)
• Priscillah Nyakundi
• Sidney Michael O'Grady, M.S., R.PH., D.PH.
• Stephen O'Grady, MD
• Thomas Joseph Godinez O'Meara, DMD

• Oral and Maxillofacial Surgery (Dentist) in Ada, OK
• Providers in Ada, 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 Nov 23, 2022; 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.