Main Street Dental, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

6531 Issued in OK

Legal business name

MAIN STREET DENTAL, PLLC

Practice address

409 E Main St
Locust Grove, OK 74352-5116

Phone

(918) 845-5505

NPI assigned

Feb 6, 2018

Organization subpart

No

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

Authorized official

Name

Dr. David Henry, DDS

Title

Owner

Phone

(918) 479-8020

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519948800000",
    "number": "1679072664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 FOREST HILL DR",
            "city": "CLAREMORE",
            "state": "OK",
            "postal_code": "74017",
            "telephone_number": "918-845-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 E MAIN ST",
            "city": "LOCUST GROVE",
            "state": "OK",
            "postal_code": "743525116",
            "telephone_number": "918-845-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-03-02",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-479-8020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OK",
            "license": "6531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Johnson
• Nora Koepp
• Living by Design LLC
• Locust Grove Care Center LLC
• Amelia Joyce Looney
• Clinton C. Moore, D.C.
• Tracy Moore
• Chelsi Moss
• Dolly Murphy
• Mai T Nguyen, PHARMD

• Dental Clinic/Center in Locust Grove, OK
• Providers in Locust Grove, 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 Mar 2, 2018; 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.