NPIMap

Organization Active NPI

Boomer Family Dentistry, PLLC

  • General Practice Dentistry
  • Norman, OK
National Provider Identifier
1407252117
Registry record updated Nov 6, 2014
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5906 Issued in OK
Legal business name
BOOMER FAMILY DENTISTRY, PLLC
Practice address
801 24TH Ave NW
Norman, OK 73069-6313
Phone
(405) 360-9117
NPI assigned
Nov 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2014

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

Authorized official

Name
Patti Klein
Title
Office Manager
Phone
(405) 360-9117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5906 OK Primary

Addresses

Primary practice location

801 24TH Ave NW
Norman, OK 73069-6313

Mailing address

801 24TH Ave NW
Norman, OK 73069-6313
Phone (405) 360-9117

National Provider Directory

National Provider Directory

Locations

801 24th Ave NW
Norman, OK 73069
Phone (405) 360-9117

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415232000000",
    "number": "1407252117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 24TH AVE NW",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696313",
            "telephone_number": "405-360-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 24TH AVE NW",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696313",
            "telephone_number": "405-360-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOMER FAMILY DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2014-11-06",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "PATTI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-360-9117"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "5906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; 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.