Oklahoma Aesthetic Reconstructive Surgery LLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

OKLAHOMA AESTHETIC RECONSTRUCTIVE SURGERY LLC

Practice address

13820 Wireless Way
Oklahoma City, OK 73134-2501

Phone

(405) 246-0391

Fax

(405) 246-0392

NPI assigned

Sep 15, 2021

Organization subpart

No

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

Authorized official

Name

Stacey Dill

Title

Office Administrator

Phone

(405) 735-9700

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635465600000",
    "number": "1932879699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 W COUNTRY CLUB DR",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731164219",
            "telephone_number": "405-246-0391",
            "fax_number": "405-246-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13820 WIRELESS WAY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731342501",
            "telephone_number": "405-246-0391",
            "fax_number": "405-246-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OKLAHOMA AESTHETIC RECONSTRUCTIVE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-15",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A",
        "authorized_official_last_name": "DILL",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "405-735-9700"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic and Reconstructive Surgery Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Plastic and Reconstructive Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.