Coffee Creek Family Dentistry

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

COFFEE CREEK FAMILY DENTISTRY

Practice address

2600 Tayler St
Edmond, OK 73003-2134

Phone

(405) 844-6333

Fax

(405) 844-6331

NPI assigned

Oct 10, 2018

Last updated

Jan 20, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mack T. Rudd, DDS

Title

Owner

Phone

(405) 844-6333

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Korbin Hally, DDS

  • General Practice Dentistry
  • Edmond, OK
  • NPI 1154945202
  NPD
• Ina Sukut, DDS

  • Dentist
  • Edmond, OK
  • NPI 1083456727
  NPD

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

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1629543251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 TAYLER ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730032134",
            "telephone_number": "405-844-6333",
            "fax_number": "405-844-6331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 TAYLER ST",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730032134",
            "telephone_number": "405-844-6333",
            "fax_number": "405-844-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE CREEK FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-10",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "RUDD",
        "authorized_official_first_name": "MACK",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-844-6333",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randy Lynn Cochran, PSY.D.
• Emily Kathyrn Cockrell, APRN
• Holly Christina Cockrum, M.ED, LPC
• Kyle Dayton Cody
• Crystal Coetzee
• Coffee Creek Pediatric Dentistry PLLC (Children's Dentistry of Coffee Creek)
• Caitlin Dakota Coffey, BACHELORS DEGREE
• Zachary Terrell Coffey, BA IN SOCIOLOGY
• Cognitive Transformations
• Lawrence J Cohen, PHARMD, BCPP

• Dental Clinic/Center in Edmond, OK
• Providers in Edmond, OK by specialty
• Dental Clinic/Center in Oklahoma

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