Jack G Okerstrom, DDS, PA

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

KS52000 Issued in KS

Practice address

4026 W. 83Rd St
Prairie Village, KS 66208

Phone

(913) 469-9191

Fax

(913) 451-2251

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. Robert W. Fry, D.D.S., M.S., P.a.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Overland Park, KS
  • NPI 1174640874
  NPD (past)
• Jeremy R. Fry, D.D.S., M.S., LLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Overland Park, KS
  • NPI 1841569126
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387411200000",
    "number": "1295846947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11940 QUIVIRA RD",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "66213",
            "telephone_number": "913-469-9191",
            "fax_number": "913-451-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4026 W. 83RD ST",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "66208",
            "telephone_number": "913-469-9191",
            "fax_number": "913-451-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKERSTROM",
        "first_name": "JACK",
        "middle_name": "G",
        "credential": "DDS, PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "KS",
            "license": "KS52000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "284782",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brienna Taylor Ochs
• Richard Alan Ochs, D.D.S.
• Allison L Oconnor, DNP, FNP-C
• Kimberly Ogden, NP
• Okwudili Martin Okekearu, PHARMD
• Olathe Hearing Aid Inc.
• Neale Randolph Oliver, D.D.S.
• Sara Adams Oliver, D.D.S.
• Tyler Oliverio
• Brooke Olson, PT, DPT

• Orthodontics and Dentofacial Orthopedics Dentistry in Prairie Village, KS
• Providers in Prairie Village, KS by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.