Judd Caleb Burns, DMD
Individual provider Active NPI General Practice Dentistry · Jay, OK
NPI 1780438515 · NPPES record last updated Aug 15, 2024
Key facts
- NPI
- 1780438515
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 7931 (OK)
- Practice address
- 859 E Melton Dr
Jay, OK 74346-2704 - Phone
- (501) 288-1323
- NPI assigned
- Apr 17, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251125004476 | MO | Order and Referring Only - Dentist |
9335631449 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7931 | OK | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7931 | OK | Yes |
Addresses
Primary practice location
859 E Melton Dr
Jay, OK 74346-2704
Mailing address
859 E Melton Dr
Jay, OK 74346-2704
Phone (501) 288-1323
Other providers in Jay, OK
- Samantha Bratcher
- Heather Rae Bretz
- Ernest Britt
- Kristi Dean Brown
- Elizabeth Buchanan
- Karlie Rose Bush
- Christian Clair Bussey
- Callie Noell Callihan
- Cory H Carroll
- Mikel Craig Cartwright
All providers in Jay, 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 Aug 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.