Eagle Dental Corp Inc

Primary specialty

DentistTaxonomy code 122300000X

License

4594 Issued in OK

Legal business name

EAGLE DENTAL CORP INC

Practice address

6520 East Reno
Midwest City, OK 73110-2109

Phone

(405) 732-6821

Fax

(405) 732-7970

NPI assigned

Aug 12, 2006

Last updated

Aug 22, 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

Dr. Mary E Martin, DDS

Title

Ceo Vice President

Phone

(405) 732-6821

Specialties & licenses 2

Addresses

Other names 1

• Dr Steve Carson and Dr Mary Mary Martin Former legal business name

Locations

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235141029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6520 EAST RENO",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731102109",
            "telephone_number": "405-732-6821",
            "fax_number": "405-732-7970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 EAST RENO",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731102109",
            "telephone_number": "405-732-6821",
            "fax_number": "405-732-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE DENTAL CORP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO VICE PRESIDENT",
        "authorized_official_telephone_number": "405-732-6821",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "4594",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "4609",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Steve Carson and Dr Mary Mary Martin",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lori Lynne Dunham, SPEECH LANGUAGE PATH
• Rory Christopher Dunham, D.O.
• Julie Marie Duran-McCullough, REGISTERED NURSE
• Dwyer Chiropractic Clinic PC (Dwyer Chiropractic Clinic)
• Kelsey Louise Dyson, CCC-SLP
• East Sooner Dental Partners PLLC (Comfort Dental Midwest City)
• Grace Catherine Eckstrom, PT, DPT
• Economy Hearing Aid Center
• Sierra Elledge, RBT
• Lisa Ellis

• Dentist in Midwest City, OK
• Providers in Midwest City, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.