Grand Avenue Dental Studio

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GRAND AVENUE DENTAL STUDIO

Practice address

720 W Grand Ave
Chickasha, OK 73018-5743

Phone

(405) 224-1311

Fax

(405) 222-3654

NPI assigned

Feb 6, 2023

Last updated

Feb 6, 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

Tara Hanselman

Title

Office Manager

Phone

(405) 224-1311

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Grand Avenue Dental Studio2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Grand Avenue Dental Studio

  • General Practice Dentistry
  • Chickasha, OK
  • NPI 1952007528
  NPD tax ID

Practitioners 1

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.

• Richard Stuart Dillon Jr., DDS

  • Dentist
  • Chickasha, OK
  • NPI 1689803314
  NPD

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

{
    "created_epoch": "1675641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1356047922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 W GRAND AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730185743",
            "telephone_number": "405-224-1311",
            "fax_number": "405-222-3654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 W GRAND AVE",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730185743",
            "telephone_number": "405-224-1311",
            "fax_number": "405-222-3654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND AVENUE DENTAL STUDIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-06",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-04",
        "status": "A",
        "authorized_official_last_name": "HANSELMAN",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-224-1311"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RICHARD S. DILLON, DDS, PC",
            "identifier": "14764768",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grady Memorial Hospital (FOMG Clinical Medical Laboratory)
• Grady Memorial Hospital (Anesthesia Services)
• Grady Memorial Hospital
• Grady Memorial Hospital (Professional Medical Services)
• Grand Ave Dental Center PLLC
• Grand Avenue Dental Studio
• Ashley Jane Green-Young
• Candace Green
• Thomas Alvin Greenfield, M.ED., LPC, LADC
• Megan Griffin, D.D.S

• Dental Clinic/Center in Chickasha, OK
• Providers in Chickasha, OK by specialty
• Dental Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.