NPIMap

Individual provider Active NPI

Jeromy Wade Dauphin, DDS

  • Dentist
  • Oklahoma City, OK
National Provider Identifier
1679723712
Registry record updated Sep 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6141 Issued in OK
Practice address
1024 SW 104TH St
Oklahoma City, OK 73139-2990
Phone
(405) 691-1123
Fax
(405) 691-2674
NPI assigned
Sep 25, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 24108 TX
Dentist 122300000X 6141 OK Primary

Addresses

Primary practice location

1024 SW 104TH St
Oklahoma City, OK 73139-2990

Mailing address

1024 SW 104TH St
Oklahoma City, OK 73139-2990
Phone (405) 691-1123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Depot South Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252540800000",
    "number": "1679723712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 SW 104TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731392990",
            "telephone_number": "405-691-1123",
            "fax_number": "405-691-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 SW 104TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731392990",
            "telephone_number": "405-691-1123",
            "fax_number": "405-691-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUPHIN",
        "first_name": "JEROMY",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-25",
        "last_updated": "2009-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "24108",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "6141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; 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.