Serratu Omosomi Iyamah

Primary specialty

DentistTaxonomy code 122300000X

License

7354 Issued in OK

Practice address

1758 NW 82ND St
Lawton, OK 73505-2356

Phone

(580) 354-7223

NPI assigned

Jul 16, 2020

Last updated

Jul 16, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Peak Dental LLC

  • General Practice Dentistry
  • Lawton, OK
  • NPI 1811832447
  NPD (past)

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1639787617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 VILLAGE GREEN DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750527042",
            "telephone_number": "682-433-1116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1758 NW 82ND ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735052356",
            "telephone_number": "580-354-7223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IYAMAH",
        "first_name": "SERRATU",
        "middle_name": "OMOSOMI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-16",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "7354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugen Ivan, MD
• Ivanka a. Vassileva, M.D., P.C.
• James Iverson III
• Ruthanna B Ives
• Mary Elvina Ivey-Sleight, RN
• J Dean Nolan OD Inc
• J J Young (Cataract Center Anesthesia Group)
• J J Young MD (The Cataract Center of Lawton)
• Amira Jabai, BS
• Susan Jachim, BSN RB CMGT-BC

• Dentist in Lawton, OK
• Providers in Lawton, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; 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.