Active NPI
Jack A Shannon, DDS
- Dentist
- Taft, OK
National Provider Identifier
1366746117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5531
- Practice address
- 601 S 124TH St. West
Taft, OK 74463 - Phone
- (918) 682-7841
- Fax
- (918) 682-6107
- NPI assigned
- Jan 7, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5531 | OK | Primary |
Addresses
Primary practice location
601 S 124TH St. West
Taft, OK 74463
Mailing address
9807 S 225TH East Ave
Broken Arrow, OK 74014-5928
Phone (918) 519-5751
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5531 | OK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294358400000",
"number": "1366746117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9807 S 225TH EAST AVE",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740145928",
"telephone_number": "918-519-5751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 S 124TH ST. WEST",
"city": "TAFT",
"state": "OK",
"postal_code": "74463",
"telephone_number": "918-682-7841",
"fax_number": "918-682-6107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "JACK",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-01-07",
"last_updated": "2011-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "5531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taft, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.