Braden Callister, DMD
Individual provider Active NPI General Practice Dentistry · Okmulgee, OK
NPI 1780105148 · NPPES record last updated Jun 11, 2019
Key facts
- NPI
- 1780105148
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6976 (OK)
- Practice address
- 1829 S Wood Dr
Okmulgee, OK 74447-6825 - Phone
- (918) 756-6500
- NPI assigned
- Jul 6, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6976 | OK | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spring Dental Okmulgee PLLC | General Practice | Past | Accepting new patients |
| TNT Dental Services PLLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6976 | OK | Yes |
Addresses
Primary practice location
1829 S Wood Dr
Okmulgee, OK 74447-6825
Mailing address
5810 E Skelly Dr Ste 1800
Tulsa, OK 74135-6434
Phone (918) 998-0996
Other providers in Okmulgee, OK
- Michael Keith Burnside
- Nicholas Busby
- Portia Lynn Butler
- Kylia Byassee
- Marquise Elzie Calhoun Jr.
- Campbell Chiropractic L.L.C.
- Justin Dale Campbell
- Christina Michelle Capps-Johnston
- Miranda Carman
- Karen Carnes
All providers in Okmulgee, OK · General Practice Dentistry in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.