59TH Street Dental Health Center, P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6574 Issued in OK

Legal business name

59TH STREET DENTAL HEALTH CENTER, P.C.

Doing business as

ABC Dental

Practice address

309 SW 59TH St Ste 105
Oklahoma City, OK 73109-8322

Phone

(405) 631-2700

NPI assigned

May 8, 2014

Last updated

May 8, 2014By 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

Travis Boyer

Title

Owner

Phone

(405) 631-2700

Specialties & licenses 1

Addresses

Other names 1

• ABC Dental Doing business as

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

{
    "created_epoch": "1399507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399507200000",
    "number": "1306257696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 SW 59TH ST STE 105",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731098322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 SW 59TH ST STE 105",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731098322",
            "telephone_number": "405-631-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "59TH STREET DENTAL HEALTH CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-08",
        "last_updated": "2014-05-08",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-631-2700"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ABC Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Oklahoma City, OK
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; 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.