Courtney Mickle-Dittrich, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7904 Issued in OK

Practice address

1334 N Lansing Ave
Tulsa, OK 74106-5907

Phone

(918) 587-2171

NPI assigned

Apr 18, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Morton Comprehensive Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Tulsa, OK
  • NPI 1275528085
  Medicare reassignment NPD
• Morton Comprehensive Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Tulsa, OK
  • NPI 1215922844
  NPD
• Morton Comprehensive Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Tulsa, OK
  • NPI 1457166522
  NPD
• Morton Comprehensive Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Tulsa, OK
  • NPI 1205822830
  NPD (past)
• Morton Comprehensive Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Nowata, OK
  • NPI 1538155163
  NPD (past)

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1376230698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9527 N 143RD EAST CT",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "740554950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1334 N LANSING AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741065907",
            "telephone_number": "918-587-2171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Brunswick Medical Center Pkwy NE",
            "address_purpose": "LOCATION",
            "city": "Bolivia",
            "state": "NC",
            "postal_code": "284221001",
            "country_code": "US",
            "telephone_number": "910-253-9000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKLE-DITTRICH",
        "first_name": "COURTNEY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-18",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "7904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Scott, Inc
• Joseph Michie, MD
• Michigan Intraoperative Neurology PC
• Michigan Spine Services PLLC
• Galina Bogdan Michka, ARNP
• Jaquetta Yvette Mickles
• Microvas Treatment Centers of America
• Mid America Surgical Systems LLC
• Cassidy Ann Middlebrook
• Tara Kay Middleton, LMSW

• General Practice Dentistry in Tulsa, OK
• Providers in Tulsa, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.