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Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7292 Issued in OK

Practice address

402 S Oakwood Rd Ste D
Enid, OK 73703-4945

Phone

(580) 242-5862

NPI assigned

Jun 13, 2020

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. Siona Motufau Jr. DDS Co

  • Oral and Maxillofacial Surgery (Dentist)
  • Grand Junction, CO
  • NPI 1144078684
  Medicare reassignment NPD CO, General Practice
• Enid Dentistry & Braces

  • Dental Clinic/Center
  • Enid, OK
  • NPI 1780105122
  NPD
• Dr. Siona Motufau Jr. DDS Co

  • Oral and Maxillofacial Surgery (Dentist)
  • Montrose, CO
  • NPI 1962892810
  NPD General Practice
• Steven C. Durr, D.D.S.

  • Dental Clinic/Center
  • Enid, OK
  • NPI 1356515282
  NPD (past)

Specialty

DentistAlso: Oral Surgery

Education

Midwestern University College of Dental Medicine, Glendale, 2020

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 13, 2020.

{
    "created_epoch": "1592006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592006400000",
    "number": "1669097804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 S OAKWOOD RD STE D",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737034945",
            "telephone_number": "580-242-5862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S OAKWOOD RD STE D",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737034945",
            "telephone_number": "580-242-5862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOGO",
        "first_name": "ACE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-13",
        "last_updated": "2020-06-13",
        "certification_date": "2020-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "7292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@eniddentistryandbraces.com",
            "affiliation": "N",
            "endpointDescription": "Office email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "402 S Oakwood Rd Ste D",
            "city": "Enid",
            "state": "OK",
            "country_code": "US",
            "postal_code": "737034945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maureen Lindley, LPC
• Chang Liu Lipinski, DO
• Lisa Irwin, LLC
• Living Center, LLC
• Erin M Logan, M.S. LPC
• Angela Grace Long, PA-C
• Jocelyn Elise Long
• Angelica Maria Lopez, MD
• Brittney C. Lorenz
• Haley Lough, LMFT-C

• All providers in Enid, OK
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.