NPIMap

Organization Active NPI

Dental Professionals of Oklahoma, PC

Doing business as Little River Dental Care

  • Dentist
  • Moore, OK
National Provider Identifier
1649000605
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
DENTAL PROFESSIONALS OF OKLAHOMA, PC
Doing business as
Little River Dental Care
Practice address
711 SW 19TH St Ste 100
Moore, OK 73160-2966
Phone
(405) 913-7622
NPI assigned
Aug 5, 2024
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF OKLAHOMA, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Authorized official

Name
Cemyira McDougal
Title
Credentialing Coordinator
Phone
(217) 764-8609

Specialties & licenses 1

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

Addresses

Primary practice location

711 SW 19TH St Ste 100
Moore, OK 73160-2966

Mailing address

711 SW 19TH St Ste 100
Moore, OK 73160-2966
Phone (405) 913-7622

Other names 1

  • Little River Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Ok PC10 organizations share this tax ID, including this one
Part of
Dental Professionals of Ok PC

Other organizations with this tax ID 9

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

Locations

711 SW 19th St
Ste 100
Moore, OK 73160
Phone (405) 913-7622

NPI Registry JSON

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

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1649000605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 SW 19TH ST STE 100",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602966",
            "telephone_number": "405-913-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 SW 19TH ST STE 100",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731602966",
            "telephone_number": "405-913-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF OKLAHOMA, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF OKLAHOMA, PC",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A",
        "authorized_official_last_name": "MCDOUGAL",
        "authorized_official_first_name": "CEMYIRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-764-8609"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little River Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; 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.