Clinton Neal Hetrick, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4416 Issued in OK

Practice address

1522 W 8TH Ave
Stillwater, OK 74074-4372

Phone

(405) 372-8300

Fax

(405) 377-0090

NPI assigned

Mar 23, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Smile Studio - Stillwater, PLLC

  • Dentist
  • Stillwater, OK
  • NPI 1174202881
  NPD (past)

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720105067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 W 8TH AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744372",
            "telephone_number": "405-372-8300",
            "fax_number": "405-377-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 W 8TH AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744372",
            "telephone_number": "405-372-8300",
            "fax_number": "405-377-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETRICK",
        "first_name": "CLINTON",
        "middle_name": "NEAL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clayton Herr, D.PH.
• Matthew Reed Herrill, M.S., ATC, LAT
• Kayla Nicole Herrington
• Diana Marcela Hess, PHARMD
• Simeon Hester
• Brandon Scott Hetzler, ATC, LAT
• Tona M Hetzler, ED.D, ATC
• Stephen Kyle Hicks, BS CMD BHRS
• Heather Higgins
• Martha Higgins

• General Practice Dentistry in Stillwater, OK
• Providers in Stillwater, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.