Joan Maza Attridge, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

140 Issued in OK

Practice address

1201 Heritage Cir
Pawnee, OK 74058-3744

Phone

(918) 762-6561

Fax

(187) 623-5439

NPI assigned

Jun 24, 2009

Last updated

Apr 19, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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

Interoperability endpoints

• Direct secure messaging: jattridge828869@ahs.direct-ci.com

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

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1902034382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 7TH ST NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333360",
            "telephone_number": "218-355-3230",
            "fax_number": "218-335-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 HERITAGE CIR",
            "city": "PAWNEE",
            "state": "OK",
            "postal_code": "740583744",
            "telephone_number": "918-762-6561",
            "fax_number": "187-623-5439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATTRIDGE",
        "first_name": "JOAN",
        "middle_name": "MAZA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-24",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020044",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "S141",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OK",
            "license": "140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahs Pawnee Hospital LLC (Pawnee Municipal Hospital)
• Ahs Pawnee Hospital LLC (Pawnee Municipal Hospital)
• Assoc Holdings LLC (Phoenix Medical Center)
• Michelle Cecilia Basile
• Laura Baumeister, APRN, PMHNP
• April Renee Bohnstedt
• Logan Bone
• Boss Medical, LLC

• Pediatric Dentistry in Pawnee, OK
• Providers in Pawnee, OK by specialty
• Pediatric Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.