Active NPI
Tevin Renken
- Dentist
- Fort Sill, OK
National Provider Identifier
1730810979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 61863
- Practice address
- 605 Randolph Road
USA Dental Health Activity, Cowan DC
Fort Sill, OK 73503-5645 - Phone
- (580) 442-5925
- NPI assigned
- Jun 20, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 61863 | KS | Primary |
Addresses
Primary practice location
605 Randolph Road
USA Dental Health Activity, Cowan DC
Fort Sill, OK 73503-5645
Mailing address
605 Randolph Rd
Fort Sill, OK 73503-4535
Phone (580) 442-5925
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61863 | KS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655683200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693008000000",
"number": "1730810979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 RANDOLPH RD",
"city": "FORT SILL",
"state": "OK",
"postal_code": "735034535",
"telephone_number": "580-442-5925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 RANDOLPH ROAD",
"address_2": "USA DENTAL HEALTH ACTIVITY, COWAN DC",
"city": "FORT SILL",
"state": "OK",
"postal_code": "735035645",
"telephone_number": "580-442-5925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENKEN",
"first_name": "TEVIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-20",
"last_updated": "2023-08-26",
"certification_date": "2023-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KS",
"license": "61863",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.