Mark Gilstrap, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

119 Issued in OK

Practice address

404 S Elm St Ste 108
Jenks, OK 74037-3714

Phone

(918) 417-2417

NPI assigned

Apr 17, 2017

Last updated

Mar 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Gilstrap Services LLC

  dba Floss Boss Pediatric Dentistry

  • Pediatric Dentistry
  • Broken Arrow, OK
  • NPI 1588400873
  NPD Authorized official

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1710411715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8223 S QUEBEC ST STE O",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801123173",
            "telephone_number": "720-277-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 S ELM ST STE 108",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740373714",
            "telephone_number": "918-417-2417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13123 E 16th Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800457106",
            "country_code": "US",
            "telephone_number": "720-777-6788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8223 S Quebec St Ste O",
            "address_purpose": "LOCATION",
            "city": "Centennial",
            "state": "CO",
            "postal_code": "80112",
            "country_code": "US",
            "telephone_number": "720-277-5930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILSTRAP",
        "first_name": "MARK",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-17",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CO",
            "license": "DEN.00203438",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MO",
            "license": "2020006360",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OK",
            "license": "119",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Catherine Gassett
• Cherrah Giles
• Serina Lynn Gilhouse
• Gilmore Chiropractic PLLC (Jenks Clinic of Chiropractic)
• William Keith Gilmore, D.C.
• Sara Gomendi, ND
• Anna Gomez, RN
• Alice Yiran Gong
• Christy Goodwin, PHARMD
• Gordon Chiropractic, PLLC

• Pediatric Dentistry in Jenks, OK
• Providers in Jenks, OK by specialty
• Pediatric Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.