NPIMap

Organization Active NPI

Board of Regents of the University of Oklahoma - Ou Denitstry

  • Dentist
  • Oklahoma City, OK
National Provider Identifier
1629110119
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU DENITSTRY
Practice address
1201 N Stonewall
Room 494
Oklahoma City, OK 73117-1214
Phone
(405) 271-5714
Fax
(405) 271-2405
NPI assigned
Feb 13, 2007
Last updated
Apr 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Authorized official

Name
D. Michelle Park
Title
Director
Phone
(405) 271-8001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

1201 N Stonewall
Room 494
Oklahoma City, OK 73117-1214

Mailing address

1201 N Stonewall Ave RM 321
Oklahoma City, OK 73117-1214
Phone (405) 271-8001

Other identifiers 1

IdentifierTypeStateIssuer
100745050AMedicaidOK

Other names 1

  • University Dental Faculty Group Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050314000819 OK Part B Supplier - Clinic/Group Practice 9436104346 Receives reassigned benefits from 11 practitioners
Practice locations: Oklahoma City, OK

National Provider Directory

National Provider Directory
Tax ID family
Board of Regents of the University of Oklahoma - Ou Denitstry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1001 Stanton L Young Blvd
Rm 494
Oklahoma City, OK 73117
Phone (405) 271-5714

1201 N Stonewall Ave
Rm 321
Oklahoma City, OK 73117

1201 N Stonewall Ave
Rm 494
Oklahoma City, OK 73117
Phone (405) 271-4034

1201 N Stonewall Ave
Ste 321
Oklahoma City, OK 73117

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1629110119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 N STONEWALL AVE RM 321",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731171214",
            "telephone_number": "405-271-8001",
            "fax_number": "405-271-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 N STONEWALL",
            "address_2": "ROOM 494",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731171214",
            "telephone_number": "405-271-5714",
            "fax_number": "405-271-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF REGENTS OF THE UNIVERSITY OF OKLAHOMA - OU DENITSTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "D.",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "405-271-8001"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100745050A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Dental Faculty Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.