Heritage Dental Group LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6017 Issued in OK

Legal business name

HERITAGE DENTAL GROUP LLC

Practice address

3600 W Tecumseh Rd
Norman, OK 73072

Phone

(405) 310-3111

NPI assigned

Dec 19, 2016

Last updated

Mar 13, 2024By 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

Elie E. Abou-Nassar, DDSNPI 1366603987

Title

Owner

Phone

(405) 310-3111

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elie Abou Nassar, DDS

  • Dentist
  • Norman, OK
  • NPI 1366603987

  General Practice

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1482105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1881139319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 W TECUMSEH RD",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730721840",
            "telephone_number": "405-701-3111",
            "fax_number": "405-701-2524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 W TECUMSEH RD",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "73072",
            "telephone_number": "405-310-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-19",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "ABOU-NASSAR",
        "authorized_official_first_name": "ELIE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-310-3111",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janette Henry
• Jayson D Henry, DO
• Sarah A Henry, COTA/L
• Allyson Henson, M.S. CCC-SLP
• Waylonda Carol Herbert, LPN II
• Heritage Therapeutic Inc
• Heritage Therapeutic Services
• Heritage Therapeutic Services
• Isabel Hernandez Saenz
• Caitlan Hernandez

• General Practice Dentistry in Norman, OK
• Providers in Norman, 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 Mar 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.