Custom Dental of Newcastle, PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

6098 Issued in OR

Legal business name

CUSTOM DENTAL OF NEWCASTLE, PLLC

Practice address

3290 N Tri-City
Newcastle, OK 73065

Phone

(405) 657-0038

NPI assigned

Aug 4, 2011

Last updated

Aug 4, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rene Rodgers

Title

Chief Operating Officer

Phone

(405) 282-6440

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312416000000",
    "number": "1871872135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3290 N TRI-CITY",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "73065",
            "telephone_number": "405-657-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3290 N TRI-CITY",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "73065",
            "telephone_number": "405-657-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM DENTAL OF NEWCASTLE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "RENE",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "405-282-6440"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "6098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rebecca Doll
• Amy Lynne Duncan
• Jeffrey Duncan, PTA
• Ellison Chiropractic LLC

• Dentist in Newcastle, OK
• Providers in Newcastle, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.