NPIMap

Organization Active NPI

Mullasseril PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Shawnee, OK
National Provider Identifier
1922366475
Registry record updated Jul 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
172 Issued in OK
Legal business name
MULLASSERIL PC
Doing business as
Shawnee Orthodontics
Practice address
504 Shawnee Mall Dr
Shawnee, OK 74804-1317
Phone
(405) 878-8899
Fax
(405) 878-8896
NPI assigned
May 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2012

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

Authorized official

Name
Dr. Anaita N Mullasseril, BDS, MSNPI 1053558254
Title
President
Phone
(405) 878-8899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 172 OK Primary

Addresses

Primary practice location

504 Shawnee Mall Dr
Shawnee, OK 74804-1317

Mailing address

504 Shawnee Mall Dr
Shawnee, OK 74804-1317
Phone (405) 878-8899

Other identifiers 1

IdentifierTypeStateIssuer
200432170AMedicaidOK

Other names 1

  • Shawnee Orthodontics Doing business as

National Provider Directory

National Provider Directory

Locations

504 Shawnee Mall Dr
Shawnee, OK 74804
Phone (405) 878-8899

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341360000000",
    "number": "1922366475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 SHAWNEE MALL DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041317",
            "telephone_number": "405-878-8899",
            "fax_number": "405-878-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 SHAWNEE MALL DR",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041317",
            "telephone_number": "405-878-8899",
            "fax_number": "405-878-8896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULLASSERIL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-02",
        "last_updated": "2012-07-04",
        "status": "A",
        "authorized_official_last_name": "MULLASSERIL",
        "authorized_official_first_name": "ANAITA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-878-8899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "BDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OK",
            "license": "172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200432170A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shawnee Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawnee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2012; 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.