Dental Boutique PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DENTAL BOUTIQUE PLLC

Practice address

3621 NW 63Rd St Ste C
Oklahoma City, OK 73116-2041

Phone

(405) 848-8838

Fax

(405) 810-0043

NPI assigned

Nov 7, 2019

Organization subpart

No

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

Authorized official

Name

Kameliya Chervilov, DDSNPI 1447746565

Title

Owner

Phone

(405) 848-8838

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Kameliya Chervilov, DDS

  • Dentist
  • Oklahoma City, OK
  • NPI 1447746565
  NPD Authorized official

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

{
    "created_epoch": "1573084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1922643543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 NW 63RD ST STE C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731162041",
            "telephone_number": "405-848-8838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 NW 63RD ST STE C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731162041",
            "telephone_number": "405-848-8838",
            "fax_number": "405-810-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL BOUTIQUE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-07",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "CHERVILOV",
        "authorized_official_first_name": "KAMELIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-848-8838",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wynonne Dennis
• Michelle Evangeline Dennison, LD
• Jennifer Lee Denny, OTRL
• Je'Ana Denson
• Lataurus Denson
• Dental Depot 62ND & South Western PLLC
• Dental Depot Hefner Station
• Dental Depot of 10004 South Memorial Drive PLLC
• Dental Depot of 145TH & N. Penn
• Dental Depot of 164TH & Portland PLLC

• General Practice Dentistry in Oklahoma City, OK
• Providers in Oklahoma City, 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 Dec 8, 2022; 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.