Active NPI
Cody Duc Van
- General Practice Dentistry
- Broken Arrow, OK
National Provider Identifier
1295628659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8055
- Practice address
- 1950 W Kenosha St
Broken Arrow, OK 74012-8944 - Phone
- (918) 518-1526
- NPI assigned
- Jun 2, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8055 | OK | Primary |
Addresses
Primary practice location
1950 W Kenosha St
Broken Arrow, OK 74012-8944
Mailing address
2219 E 11TH St Unit 204
Tulsa, OK 74104-3641
Phone (316) 680-9288
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8055 | OK | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748822400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748822400000",
"number": "1295628659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2219 E 11TH ST UNIT 204",
"city": "TULSA",
"state": "OK",
"postal_code": "741043641",
"telephone_number": "316-680-9288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 W KENOSHA ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128944",
"telephone_number": "918-518-1526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN",
"first_name": "CODY",
"middle_name": "DUC",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-06-02",
"last_updated": "2025-06-02",
"certification_date": "2025-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "8055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.