Michael J. Gliddon Dba Live Oak Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

160 Issued in OK

Legal business name

MICHAEL J. GLIDDON DBA LIVE OAK ORAL SURGERY

Practice address

1415 NW 33Rd St
Lawton, OK 73505-3806

Phone

(580) 699-3131

Fax

(580) 699-3151

NPI assigned

Dec 6, 2010

Last updated

Nov 13, 2013By 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

Vera Ann Wellner

Title

Credentialing Rep

Phone

(405) 848-7974

Specialties & licenses 1

Addresses

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.

• Michael John Gliddon, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Lawton, OK
  • NPI 1285604553
  NPD (past)

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

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1265735724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 UNITED FOUNDERS BLVD",
            "address_2": "SUITE 237",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731123958",
            "telephone_number": "405-848-7974",
            "fax_number": "405-848-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 NW 33RD ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735053806",
            "telephone_number": "580-699-3131",
            "fax_number": "580-699-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. GLIDDON DBA LIVE OAK ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-06",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "WELLNER",
        "authorized_official_first_name": "VERA ANN",
        "authorized_official_title_or_position": "CREDENTIALING REP",
        "authorized_official_telephone_number": "405-848-7974"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OK",
            "license": "160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Lynn Mertz
• Jennifer Michelle Meyer, FNP-C
• Kari Leilani Meyer, MS, CCC-SLP
• Stacy Meyer
• Jose Meza, D.O
• Jaesa Jean Michel
• Scott Lewis Michener, MD
• Pamela Evelyn Middleton
• Ashraf R Mihanni, MD
• Robert S Milan, LADC

• Oral and Maxillofacial Surgery (Dentist) in Lawton, OK
• Providers in Lawton, 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 13, 2013; 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.