John R Smith, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1242 Issued in OK

Practice address

Hwy 56 & 270 Junction
Wewoka, OK 74884-1475

Phone

(405) 257-7318

Fax

(405) 257-2696

NPI assigned

Apr 25, 2008

Sex

Male

Sole proprietor

Yes

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

Enrolled in TX

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Plaza Medical Group PC

  • Cardiovascular Disease Physician
  • Oklahoma City, OK
  • NPI 1295731792
  NPD (past)
• Wewoka Indian Health

  • Community Health Clinic/Center
  • Wewoka, OK
  • NPI 1689664195
  NPD (past)

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209081600000",
    "number": "1891960399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1475",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748841475",
            "telephone_number": "405-257-7318",
            "fax_number": "405-257-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 56 & 270 JUNCTION",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748841475",
            "telephone_number": "405-257-7318",
            "fax_number": "405-257-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JOHN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "1242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Nicole Polson, RN
• Troy Ray
• Shannon Roden, M.ED., SLP
• Saints Medical Group, LLC
• Jennifer Sharma, RN
• Misty Smith
• Susan D Sollars
• Springhill Healthcare LLC
• Gladys E Stephney, CADC UNDER SUPERVISI
• Royce Street

• General Practice Dentistry in Wewoka, OK
• Providers in Wewoka, 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 Apr 25, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.