Dixieland Dental, Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5733 Issued in OK

Legal business name

DIXIELAND DENTAL, INC

Practice address

4117 NW 122ND St
Suite C
Oklahoma City, OK 73120-8869

Phone

(405) 751-4466

Fax

(405) 608-0163

NPI assigned

Jun 24, 2008

Organization subpart

No

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

Authorized official

Name

Katy Shapard

Title

Office Manager

Phone

(405) 751-4466

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nathan Shapard, DDS Doing business as

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1932360765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4117 NW 122ND ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208869",
            "telephone_number": "405-751-4466",
            "fax_number": "405-608-0163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 NW 122ND ST",
            "address_2": "SUITE C",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731208869",
            "telephone_number": "405-751-4466",
            "fax_number": "405-608-0163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIXIELAND DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "SHAPARD",
        "authorized_official_first_name": "KATY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-751-4466"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "5733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200068560A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nathan Shapard, DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Divine Holistic Intervention Services LLC.
• Mable Catherine Dixon-Shelton
• Alexis M Dixon, LMSW
• Avani Dixon
• Cheryl Lynn Dixon
• Erin M Dixon, RD, LD

• 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 Jun 24, 2008; 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.