Kenosha Breeze Family Dental PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

KENOSHA BREEZE FAMILY DENTAL PLLC

Practice address

901 W Kenosha St
Broken Arrow, OK 74012-8918

Phone

(918) 258-8658

NPI assigned

Sep 18, 2018

Last updated

May 8, 2023By 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

Amanda Lightfoot

Title

Authorized Representative

Phone

(214) 702-0708

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Dennis J. Carlile, D.D.S.

  • General Practice Dentistry
  • Broken Arrow, OK
  • NPI 1700986379
  NPD (past)
• Brittany Macleod, DDS

  • Dentist
  • Broken Arrow, OK
  • NPI 1609214550
  NPD (past)

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683504000000",
    "number": "1346724044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15660 DALLAS PKWY STE 925",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752483323",
            "telephone_number": "214-702-0729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W KENOSHA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740128918",
            "telephone_number": "918-258-8658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA BREEZE FAMILY DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-18",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "LIGHTFOOT",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "214-702-0708"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooklyn Danielle Kelly, COTA/L
• Rustyn Kelly
• Shelly Marie Kennedy-Gonzalez, LPC
• Karissa Brooke Kennedy
• Lauren Kennison
• Bailey Rae Keough
• Whitney Rochelle Kern, FNP
• Rebecca Lynn Kerr
• Elyse Robin Kester
• Serenity Dawn Ketterman

• Dentist in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.