NPIMap

Organization Active NPI

Mt Lincoln PLLC

Doing business as Dental Depot of Yukon

  • General Practice Dentistry
  • Yukon, OK
National Provider Identifier
1902070063
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3723 Issued in OK
Legal business name
MT LINCOLN PLLC
Doing business as
Dental Depot of Yukon
Practice address
701 Shedeck Parkway
Yukon, OK 73099
Phone
(405) 350-1133
Fax
(405) 350-1139
NPI assigned
Apr 18, 2008
Last updated
Jun 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Authorized official

Name
Bryson Pogson
Title
Dir. of Business Development
Phone
(405) 945-8941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3723 OK Primary

Addresses

Primary practice location

701 Shedeck Parkway
Yukon, OK 73099

Mailing address

2828 NW 30TH St
Oklahoma City, OK 73112-7404
Phone (405) 350-1133

Other names 1

  • Dental Depot of Yukon Doing business as

National Provider Directory

National Provider Directory

Locations

701 Shedeck Pkwy
Yukon, OK 73099
Phone (405) 350-1133

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624579200000",
    "number": "1902070063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 NW 30TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731127404",
            "telephone_number": "405-350-1133",
            "fax_number": "405-350-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SHEDECK PARKWAY",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "73099",
            "telephone_number": "405-350-1133",
            "fax_number": "405-350-1139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT LINCOLN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A",
        "authorized_official_last_name": "POGSON",
        "authorized_official_first_name": "BRYSON",
        "authorized_official_title_or_position": "DIR. OF BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "405-945-8941"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "3723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Depot of Yukon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dental Depot of Yukon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yukon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; 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.