Active NPI
Jorge Madamba, DDS
- Dentist
- Midwest City, OK
National Provider Identifier
1821031188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3173
- Practice address
- 304 S Air Depot Blvd
Midwest City, OK 73110-4433 - Phone
- (405) 733-0002
- Fax
- (405) 741-2230
- NPI assigned
- Jun 14, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3173 | OK | Primary |
Addresses
Primary practice location
304 S Air Depot Blvd
Midwest City, OK 73110-4433
Mailing address
555 W Benjamin Holt Dr
Building B
Stockton, CA 95207-3839
Phone (209) 476-4700
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ronald Montgomery Dental Group, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Midwest City, OK
- NPI 1093757437
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214438400000",
"number": "1821031188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 W BENJAMIN HOLT DR",
"address_2": "BUILDING B",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952073839",
"telephone_number": "209-476-4700",
"fax_number": "209-478-6890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 S AIR DEPOT BLVD",
"city": "MIDWEST CITY",
"state": "OK",
"postal_code": "731104433",
"telephone_number": "405-733-0002",
"fax_number": "405-741-2230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADAMBA",
"first_name": "JORGE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2008-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "3173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midwest City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.