NPIMap

Organization Active NPI

Dental Professionals of Oklahoma, P.C.

  • General Practice Dentistry
  • Yukon, OK
National Provider Identifier
1548557002
Registry record updated Sep 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF OKLAHOMA, P.C.
Practice address
1670 Garth Brooks Blvd
Suite 115
Yukon, OK 73099-6878
Phone
(405) 494-3080
Fax
(405) 265-3555
NPI assigned
Jul 6, 2011
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF OKLAHOMA, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2015

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

Authorized official

Name
Heather N. Pruemer
Title
Credentialing Coordinator
Phone
(217) 540-8434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1670 Garth Brooks Blvd
Suite 115
Yukon, OK 73099-6878

Mailing address

1670 Garth Brooks Blvd
Suite 115
Yukon, OK 73099-6878
Phone (405) 494-3080

Other names 1

  • Family Dentistry of Yukon Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Health Associates of Texas PC10 organizations share this tax ID, including this one
Part of
Dental Health Associates of Texas PC

Other organizations with this tax ID 9

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

Locations

1670 Garth Brooks Blvd
Ste 115
Yukon, OK 73099
Phone (405) 494-3080

NPI Registry JSON

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

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1548557002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 GARTH BROOKS BLVD",
            "address_2": "SUITE 115",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996878",
            "telephone_number": "405-494-3080",
            "fax_number": "405-265-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 GARTH BROOKS BLVD",
            "address_2": "SUITE 115",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996878",
            "telephone_number": "405-494-3080",
            "fax_number": "405-265-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF OKLAHOMA, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF OKLAHOMA,  P.C.",
        "enumeration_date": "2011-07-06",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "PRUEMER",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8434"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dentistry of Yukon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yukon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.