NPIMap

Organization Active NPI

Advantage Dental Oral Health Center of Oklahoma, P.C.

Doing business as Advantage Dental Plus

  • General Practice Dentistry
  • Broken Arrow, OK
National Provider Identifier
1386412328
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ADVANTAGE DENTAL ORAL HEALTH CENTER OF OKLAHOMA, P.C.
Doing business as
Advantage Dental Plus
Practice address
2619 S Elm PL
Broken Arrow, OK 74012-7878
Phone
(918) 872-0218
Fax
(918) 872-0892
NPI assigned
Dec 19, 2023
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVANTAGE DENTAL ORAL HEALTH CENTER OF OKLAHOMA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Sherrie Edmondson
Title
Sr Manager
Phone
(629) 999-5014

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X
General Practice Dentistry 1223G0001X Primary
Pediatric Dentistry 1223P0221X
Oral and Maxillofacial Surgery (Dentist) 1223S0112X

Addresses

Primary practice location

2619 S Elm PL
Broken Arrow, OK 74012-7878

Mailing address

63140 Britta St Ste D104
Bend, OR 97703-5738
Phone (629) 999-5014

Other practice location 1

1040 NE 36th St
Oklahoma City, OK 73111-5002
Phone (405) 967-7742

Other names 1

  • Advantage Dental Plus Doing business as

National Provider Directory

National Provider Directory
Part of
Advantage Dental Oral Health Center of Oklahoma PC

Locations

2619 S Elm Pl
Broken Arrow, OK 74012
Phone (918) 455-0811

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1702944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1386412328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63140 BRITTA ST STE D104",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977035738",
            "telephone_number": "629-999-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 S ELM PL",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127878",
            "telephone_number": "918-872-0218",
            "fax_number": "918-872-0892"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1040 NE 36th St",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731115002",
            "country_code": "US",
            "telephone_number": "405-967-7742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL ORAL HEALTH CENTER OF OKLAHOMA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANTAGE DENTAL ORAL HEALTH CENTER OF OKLAHOMA, P.C.",
        "enumeration_date": "2023-12-19",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "SHERRIE",
        "authorized_official_title_or_position": "SR MANAGER",
        "authorized_official_telephone_number": "629-999-5014"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advantage Dental Plus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advantage Dental Plus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; 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.