Ok Oms Specialty Dental Services, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

OK OMS SPECIALTY DENTAL SERVICES, PLLC

Doing business as

Edmond Pediatric and Teen Dentistry

Practice address

101 S Saints Blvd Ste 212
Edmond, OK 73034-3083

Phone

(405) 513-8811

NPI assigned

Mar 13, 2025

Last updated

Mar 13, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

OK OMS SPECIALTY DENTAL SERVICES, PLLCAs reported in NPPES

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

Authorized official

Name

Charlotte V Dasch

Title

Director of Cred and Prov Rel

Phone

(615) 678-0759

Specialties & licenses 1

Addresses

Other names 1

• Edmond Pediatric and Teen Dentistry Doing business as

Tax ID family

Ok Oms Specialty Dental Services PLLC3 organizations share this tax ID, including this one

Part of

Ok Oms Specialty Dental Services PLLC

Other organizations with this tax ID 2

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

• Ok Oms Specialty Dental Services

  dba Wisdom Teeth OKC

  • Oral and Maxillofacial Surgery (Dentist)
  • Oklahoma City, OK
  • NPI 1164276572
  NPD tax ID
• Ok Oms Specialty Dental Services

  • Oral and Maxillofacial Surgery (Dentist)
  • Oklahoma City, OK
  • NPI 1649024050
  NPD tax ID

Locations

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.

• Ok Oms Specialty Dental Services

  • Oral and Maxillofacial Surgery (Dentist)
  • Oklahoma City, OK
  • NPI 1649024050
  NPPES parent name

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

{
    "created_epoch": "1741824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741824000000",
    "number": "1437958196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 54TH AVE N STE 205",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372091442",
            "telephone_number": "615-678-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 S SAINTS BLVD STE 212",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730343083",
            "telephone_number": "405-513-8811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OK OMS SPECIALTY DENTAL SERVICES, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OK OMS SPECIALTY DENTAL SERVICES, PLLC",
        "enumeration_date": "2025-03-13",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A",
        "authorized_official_last_name": "DASCH",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "DIRECTOR OF CRED AND PROV REL",
        "authorized_official_telephone_number": "615-678-0759"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edmond Pediatric and Teen Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jonathan Oglesby, BHRS
• Landre Tatum Oglesby, ATC
• Oyefunke Abidemi Ogunbanwo
• Alexander Ogunseye, COTA/L
• Sally Oh
• Ok Psych NP LLC
• Ok Specialty Dental Services PLLC (Edmond Pediatric & Teen Dentistry)
• Ok-Theraplay
• Okc Dental Health Associates, P.C. (Dental Care of Edmond)
• Oklahoma Algiatry Group

• Oral and Maxillofacial Surgery (Dentist) in Edmond, OK
• Providers in Edmond, OK by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.