Summer Dental Shawnee PLLC
Organization Active NPI Dentist · Shawnee, OK
NPI 1548834872 · NPPES record last updated May 20, 2021
Key facts
- NPI
- 1548834872
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- SUMMER DENTAL SHAWNEE PLLC
- Practice address
- 3703 N Kickapoo Ave
Shawnee, OK 74804-1703 - Phone
- (405) 275-0640
- NPI assigned
- May 20, 2021
- Organization subpart
- No
Authorized official
- Name
- Mike Yates
- Title
- Coo
- Phone
- (918) 998-0996
Practitioners 9
-
Michael Bennett, DMD
-
Brock Wesley Nichols, DDS
-
Glenn Davis, D.D.S.
-
Decker James Lardner, DDS
-
Nicholas Novakovich, DMD
-
Christian Brown, DDS
National Provider Directory
Locations
3703 N Kickapoo Ave
Shawnee, OK 74804
Phone (405) 275-0640
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes |
Addresses
Primary practice location
3703 N Kickapoo Ave
Shawnee, OK 74804-1703
Mailing address
400 Riverwalk Ter Ste 250
Jenks, OK 74037-5619
Phone (918) 998-0996
NPI Registry JSON
{
"created_epoch": "1621468800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1621468800000",
"number": "1548834872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 RIVERWALK TER STE 250",
"city": "JENKS",
"state": "OK",
"postal_code": "740375619",
"telephone_number": "918-998-0996",
"fax_number": "918-310-1056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3703 N KICKAPOO AVE",
"city": "SHAWNEE",
"state": "OK",
"postal_code": "748041703",
"telephone_number": "405-275-0640"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SUMMER DENTAL SHAWNEE PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-05-20",
"last_updated": "2021-05-20",
"certification_date": "2021-05-20",
"status": "A",
"authorized_official_last_name": "YATES",
"authorized_official_first_name": "MIKE",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "918-998-0996"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.