Katelyn Mack, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

6738 Issued in OK

Practice address

4425 Grant Blvd. Custom Dental of Yukon
Yukon, OK 73099

Phone

(405) 494-4877

Fax

(405) 494-4184

NPI assigned

Jul 3, 2015

Last updated

Oct 2, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Katelyn Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Custom Dental of Yukon, PLLC

  • Dental Clinic/Center
  • Yukon, OK
  • NPI 1164049185
  NPD
• Whitwell Dentistry Inc

  • Dental Clinic/Center
  • Oklahoma City, OK
  • NPI 1538334636
  NPD (past)

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

{
    "created_epoch": "1435881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1750764031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 GRANT BLVD.",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-494-4877",
            "fax_number": "405-494-4184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 GRANT BLVD. CUSTOM DENTAL OF YUKON",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-494-4877",
            "fax_number": "405-494-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "KATELYN",
        "name_prefix": "Mrs.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-03",
        "last_updated": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "6738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF OKLAHOMA",
            "identifier": "6738",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATELYN",
            "last_name": "JOHNSON",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca Luthi, COTA
• Mildred Jeanette Lynch, M.ED
• M & M Counseling Group, LLC
• Jeremy Maass, DC
• John Mace, O.D.
• Madison Mills, LPC, NCC, LLC
• Marissa Hope Mahan
• Rebekah Mani, LMSW
• Grace Manning
• Baleigh Mansfield

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.

Verify at the official NPI Registry.