Active NPI
Ryan John Theobald, D.D.S.
- Dentist
- Mustang, OK
National Provider Identifier
1508154634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6302
- Practice address
- 1041 E Hwy 152
Mustang, OK 73064-5117 - Phone
- (405) 518-4011
- NPI assigned
- Jul 11, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6302 | OK | Primary |
Addresses
Primary practice location
1041 E Hwy 152
Mustang, OK 73064-5117
Mailing address
1041 E Hwy 152
Mustang, OK 73064-5117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6302 | OK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310342400000",
"number": "1508154634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1041 E HWY 152",
"city": "MUSTANG",
"state": "OK",
"postal_code": "730645117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1041 E HWY 152",
"city": "MUSTANG",
"state": "OK",
"postal_code": "730645117",
"telephone_number": "405-518-4011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEOBALD",
"first_name": "RYAN",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-11",
"last_updated": "2011-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "6302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mustang, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.