Blue River Smiles PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BLUE RIVER SMILES PLLC

Practice address

1202 E Main St
Tishomingo, OK 73460-2409

Phone

(580) 371-2396

NPI assigned

Mar 26, 2021

Organization subpart

No

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

Authorized official

Name

Joshua Brasher, DDS

Title

President

Phone

(405) 474-6362

Specialties & licenses 1

Addresses

Practitioners 2

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

• Austin William Brasher

  • Dentist
  • Tishomingo, OK
  • NPI 1285268771
  NPD
• Ron Austin, DDS

  • Dentist
  • Tishomingo, OK
  • NPI 1184841538
  NPD (past)

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

{
    "created_epoch": "1616716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616716800000",
    "number": "1760069520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 E COVELL RD",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346909",
            "telephone_number": "405-359-0808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 E MAIN ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734602409",
            "telephone_number": "580-371-2396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIVER SMILES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-26",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A",
        "authorized_official_last_name": "BRASHER",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-474-6362",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert G Bishop, MD
• Relinda Lea Black, APRN-CNP
• Scotty Ray Black, PHARMD
• Melissa Sue Blackburn, LPC
• Blue River Healthcare Inc.
• Amanda Kay Blue
• Joyce Lee Boone
• Lacy Anne Borengasser, LPC CANDIDATE
• Darci Lynn Bowen, APRN-CNP
• Austin William Brasher

• General Practice Dentistry in Tishomingo, OK
• Providers in Tishomingo, 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 Mar 26, 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.