Okc Prosth PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

OKC PROSTH PLLC

Practice address

11317 S Western Ave Ste 500
Oklahoma City, OK 73170-5851

Phone

(918) 998-0996

NPI assigned

Jul 20, 2021

Organization subpart

No

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

Authorized official

Name

Sara Brown

Title

Credentialing Manager

Phone

(918) 998-0996

Specialties & licenses 2

Addresses

Other names 1

• Southwest OKC Oklahoma Implants and Dentures Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Colby Troy Broadbent, DDS

  • General Practice Dentistry
  • Oklahoma City, OK
  • NPI 1558882548
  NPD (past)
• Nicholas Novakovich, DMD

  • Dentist
  • Oklahoma City, OK
  • NPI 1043886278
  NPD (past)
• Colin Archibald Young, DMD

  • General Practice Dentistry
  • Cushing, OK
  • NPI 1053807099
  NPD (past)

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1700459559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERWALK TER STE 250",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740375619",
            "telephone_number": "918-998-0996",
            "fax_number": "918-310-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11317 S WESTERN AVE STE 500",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731705851",
            "telephone_number": "918-998-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKC PROSTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "918-998-0996"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest OKC Oklahoma Implants and Dentures",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; 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.