Active NPI
Robert Blaine Mongrain Jr., DMD
- General Practice Dentistry
- Broken Arrow, OK
National Provider Identifier
1598731655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4301
- Practice address
- 8701 S Garnett Rd
Broken Arrow, OK 74012-8852 - Phone
- (918) 250-9528
- Fax
- (918) 250-9529
- NPI assigned
- Feb 27, 2006
- Last updated
- Jul 13, 2026
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4301 | OK | Primary |
Addresses
Primary practice location
8701 S Garnett Rd
Broken Arrow, OK 74012-8852
Mailing address
8701 S Garnett Rd
Broken Arrow, OK 74012-8852
Phone (918) 250-9528
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150603000722 | OK | Order and Referring Only - Dentist | 0143541177 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Professionals of Oklahoma, PC | General Practice | Past | Accepting new patients |
| Norton Crna PLLC | Past | Accepting new patients | |
| Berkshire Dental Group PLC | General Practice | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Broken Arrow, OK
- NPI 1982870838
-
dba Glisten Dental Care of Tulsa
- General Practice Dentistry
- Tulsa, OK
- NPI 1194257543
-
- Certified Registered Nurse Anesthetist
- Broken Arrow, OK
- NPI 1265899405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1598731655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8701 S GARNETT RD",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128852",
"telephone_number": "918-250-9528",
"fax_number": "918-250-9529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8701 S GARNETT RD",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128852",
"telephone_number": "918-250-9528",
"fax_number": "918-250-9529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONGRAIN",
"first_name": "ROBERT",
"middle_name": "BLAINE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "4301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.