Main Street Dental Associates

Primary specialty

DentistTaxonomy code 122300000X

License

5381 Issued in OK

Legal business name

MAIN STREET DENTAL ASSOCIATES

Practice address

1306 N Main St
Miami, OK 74354-3325

Phone

(918) 542-2858

NPI assigned

May 6, 2008

Organization subpart

No

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

Authorized official

Name

Thomas B Jourdan

Title

Dentist

Phone

(918) 256-6831

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1881860211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 N MAIN ST",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743543325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 N MAIN ST",
            "city": "MIAMI",
            "state": "OK",
            "postal_code": "743543325",
            "telephone_number": "918-542-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "JOURDAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "918-256-6831"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OK",
            "license": "5381",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "263477085001",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA",
            "identifier": "OK5381",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Mae Lundell, FNP
• Tennille Lundien
• Casey Machado
• Elaine Mary Mader, MD
• Suzanne Michelle Mahurin
• Suzanne T Mallatt, NP
• Christina Manion
• Sara Manners
• Brandon Allan Maples
• Angela Marrett, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.

Verify at the official NPI Registry.