NPIMap

Organization Active NPI

Summer Dental Shawnee PLLC

  • Dentist
  • Shawnee, OK
National Provider Identifier
1548834872
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 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
Last updated
May 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

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

Authorized official

Name
Mike Yates
Title
Coo
Phone
(918) 998-0996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

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

National Provider Directory

National Provider Directory

Locations

3703 N Kickapoo Ave
Shawnee, OK 74804
Phone (405) 275-0640

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "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. Last updated by the provider on May 20, 2021; 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.