Southeast Oklahoma Oral & Maxillofacial Surgery, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SOUTHEAST OKLAHOMA ORAL & MAXILLOFACIAL SURGERY, PC

Practice address

803 N Monte Vista St
Ada, OK 74820-7711

Phone

(580) 332-3010

Fax

(580) 332-3010

NPI assigned

Aug 25, 2005

Last updated

May 6, 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

R. Todd Boone, DDS

Title

Oral Surgeon and Owner

Phone

(580) 332-3010

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399334400000",
    "number": "1306839246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748207711",
            "telephone_number": "580-332-3010",
            "fax_number": "580-332-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 N MONTE VISTA ST",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748207711",
            "telephone_number": "580-332-3010",
            "fax_number": "580-332-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST OKLAHOMA ORAL & MAXILLOFACIAL SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2014-05-06",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "R.",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "ORAL SURGEON AND OWNER",
        "authorized_official_telephone_number": "580-332-3010",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "787600",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112550A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "444583300003",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "444583300004",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Social Services Foundation of Southern Oklahoma, Inc.
• Ronda Sockey
• Jorge Luis Solorzano, O.D.
• Laura K Soper, P.A.
• South Central Oklahoma Radiology PLLC
• Southeastern Oklahoma Family Services, Inc.
• Southeastern Oklahoma Neurosciences
• Southeastern Women's Health Center
• Southern Oklahoma Anesthesiology, Inc
• Southern Oklahoma Internal Medicine P C

• Oral and Maxillofacial Surgery (Dentist) in Ada, OK
• Providers in Ada, 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 May 6, 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.