Nicoma Park Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

NICOMA PARK DENTAL PLLC

Practice address

10420 NE 23Rd St
Oklahoma City, OK 73141-5216

Phone

(405) 603-8520

NPI assigned

Jun 27, 2018

Organization subpart

No

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

Authorized official

Name

Jason Wallace, DDSNPI 1346698842

Title

Owner

Phone

(405) 413-7466

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Jason Wallace, D.D.S.

  • General Practice Dentistry
  • Edmond, OK
  • NPI 1346698842
  NPD Authorized official

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530057600000",
    "number": "1518452952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 N BRYAN AVE",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730083001",
            "telephone_number": "405-413-7466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10420 NE 23RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731415216",
            "telephone_number": "405-603-8520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOMA PARK DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-27",
        "last_updated": "2018-06-27",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-413-7466",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheryl Nicks
• Sydney Lynn Nicol
• Nicole Decamp, MD, PC
• Nicole M. Kish, OD & Associates, PC
• Teodora O Nicolescu, MD
• Chastity Nida
• Korbin Alaina Nida
• Jeremiah Allen Nielsen
• Kaitlyn Dawn Nielsen
• Maria Angeles Nieto, RN

• Dental Clinic/Center in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Dental Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2018; 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.