Thomas Blake Sudberry, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5443 Issued in OK

Practice address

615 N. Commerce
Ardmore, OK 73401

Phone

(580) 223-6720

NPI assigned

Sep 6, 2007

Last updated

Sep 6, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 30, 2015 through Dec 30, 2027

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.

• Sudberry Dental

  • General Practice Dentistry
  • Ardmore, OK
  • NPI 1962798595
  NPD Authorized official
• Storts and Sudberry PLLC

  • Dentist
  • Ardmore, OK
  • NPI 1780778951
  NPD (past)

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189036800000",
    "number": "1801081534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N. COMMERCE",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "73401",
            "telephone_number": "580-223-6720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N. COMMERCE",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "73401",
            "telephone_number": "580-223-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDBERRY",
        "first_name": "THOMAS",
        "middle_name": "BLAKE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-06",
        "last_updated": "2007-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "5443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Stovall, RPT
• Carly Strus, APRN, CNP
• Carol M Stuart, B.S.
• Gregory R Stubbs
• Sudberry Dental
• Lisa Sudderth
• April Dawn Sullivan, PA-C
• Ruben L Sunga Jr., M.D.
• Hallie Swain
• Faith Renee Swart

• General Practice Dentistry in Ardmore, OK
• Providers in Ardmore, 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 Sep 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.