Dentrust Oklahoma, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTRUST OKLAHOMA, PC

Practice address

3360 N Ave BLDG 685
Tinker Afb, OK 73145-9028

Phone

(267) 927-5000

Fax

(267) 927-5001

NPI assigned

Jan 12, 2023

Organization subpart

Yes

Parent organization

DENTRUST OKLAHOMA, PCAs reported in NPPES

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

Authorized official

Name

Amanda Clark

Title

Director of Credentialing

Phone

(267) 362-5938

Specialties & licenses 1

Addresses

Other names 2

• Dentrust Dental PA Doing business as
• DOCS Dental Tinker AFB Other name

Electronic endpoints 1

Tax ID family

Dentrust Oklahoma PC2 organizations share this tax ID, including this one

Part of

Dentrust Oklahoma PC

Other organizations with this tax ID 1

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

• Dentrust Oklahoma, PC

  • General Practice Dentistry
  • Ft.Still, OK
  • NPI 1518598267
  NPD tax ID

Interoperability endpoints

• Direct secure messaging: tinkerafbinfo@docs.health

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Dentrust Oklahoma, PC

  • General Practice Dentistry
  • Ft.Still, OK
  • NPI 1518598267
  NPPES parent name

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1407560535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3360 N AVE BLDG 685",
            "city": "TINKER AFB",
            "state": "OK",
            "postal_code": "731459028",
            "telephone_number": "267-927-5000",
            "fax_number": "267-927-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 N AVE BLDG 685",
            "city": "TINKER AFB",
            "state": "OK",
            "postal_code": "731459028",
            "telephone_number": "267-927-5000",
            "fax_number": "267-927-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTRUST OKLAHOMA, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTRUST OKLAHOMA, PC",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "267-362-5938"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TinkerAFBInfo@docs.health",
            "affiliation": "N",
            "address_1": "3360 N Ave Bldg 685",
            "city": "Tinker AFB",
            "state": "OK",
            "country_code": "US",
            "postal_code": "731459028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Dentrust Dental PA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DOCS Dental Tinker AFB",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Nancy M. Chavez-Mozingo, IDMT
• Nathan Cook
• Yamily Cruz Soto, IDMT
• Ernest L Dabreo, D.D.S., M.S.D.
• Charlotte Yvonne Davis, R. PH.
• Department of the Air Force 72D Medical Group
• James Neal Dillard III, PA-C
• Robert Christopher Dunn, MD
• Stephen Ryan Emmerthal
• Peter Mitchell Estrada, DAT, LAT, ATC, BCS-O

• General Practice Dentistry in Tinker Afb, OK
• Providers in Tinker Afb, 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 Jan 12, 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.