Active NPI
Lee Stephen Shackelford, DDS
- Dentist
- Vinita, OK
National Provider Identifier
1780955542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6569
- Practice address
- 27515 S. 4410 Rd.
Vinita, OK 74301 - Phone
- (918) 256-4800
- Fax
- (918) 258-4586
- NPI assigned
- Jan 25, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6569 | OK | Primary |
| General Practice Dentistry | 1223G0001X | 2004032896 | MO | |
| General Practice Dentistry | 1223G0001X | 35652 | CA |
Addresses
Primary practice location
27515 S. 4410 Rd.
Vinita, OK 74301
Mailing address
27515 S. 4410 Rd.
Vinita, OK 74301
Phone (918) 256-4800
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 |
|---|---|---|---|
| 35652 | CA | MD | General Practice Dentistry |
| 2004032896 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426723200000",
"number": "1780955542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27515 S. 4410 RD.",
"city": "VINITA",
"state": "OK",
"postal_code": "74301",
"telephone_number": "918-256-4800",
"fax_number": "918-258-4586"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27515 S. 4410 RD.",
"city": "VINITA",
"state": "OK",
"postal_code": "74301",
"telephone_number": "918-256-4800",
"fax_number": "918-258-4586"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "LEE",
"middle_name": "STEPHEN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-01-25",
"last_updated": "2015-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "6569",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2004032896",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "35652",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vinita, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.