Oklahoma Periodontics

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

5447 Issued in OK

Legal business name

OKLAHOMA PERIODONTICS

Doing business as

Eastern Oklahoma Periodotnics

Practice address

6565 S Yale Ave
1008
Tulsa, OK 74136-8327

Phone

(918) 492-0737

Fax

(918) 492-9439

NPI assigned

Feb 26, 2009

Organization subpart

No

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

Authorized official

Name

Dr. William Bernard Wynn IV, D.D.S. M.S.NPI 1245359371

Title

President

Phone

(918) 492-0737

Specialties & licenses 1

Addresses

Other names 1

• Eastern Oklahoma Periodotnics Doing business as

Locations

Practitioners 2

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

• William Bernard Wynn IV, D.D.S., M.S.

  • Periodontics
  • Tulsa, OK
  • NPI 1245359371
  NPD (past) Authorized official
• Jay Frank Anderson, D.D.S.

  • Periodontics
  • Tulsa, OK
  • NPI 1457579534
  NPD (past)

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

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235606400000",
    "number": "1720228075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 S YALE AVE",
            "address_2": "1008",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368327",
            "telephone_number": "918-492-0737",
            "fax_number": "918-492-9439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6565 S YALE AVE",
            "address_2": "1008",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368327",
            "telephone_number": "918-492-0737",
            "fax_number": "918-492-9439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA PERIODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-26",
        "last_updated": "2009-02-26",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-492-0737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "D.D.S. M.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "OK",
            "license": "5447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastern Oklahoma Periodotnics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Oklahoma Pain and Wellness Center, PLC
• Oklahoma Physical Therapy
• Oklahoma Physicians Eyecare Group, P.C.
• Oklahoma Primary Care Solutions PC
• Oklahoma Psychological Associates
• Oklahoma Rehab Services, Inc.

• Periodontics in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Periodontics in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 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.