Emily Wauneka Berg Ikahihifo, DMD
Individual provider Active NPI Endodontics · Shiprock, NM
NPI 1992052674 · NPPES record last updated Jul 20, 2022
Key facts
- NPI
- 1992052674
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Endodontics 1223E0200X
- License
- DD3670 (NM)
- Practice address
- US Hwy 491 North
Shiprock, NM 87420 - Phone
- (505) 368-6001
- Fax
- (505) 368-6360
- NPI assigned
- Aug 13, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210520000459 | TX | Practitioner - Dentist | 0749689958 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD3670 | NM | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cherokee Nation | Current | Accepting new patients | |
| Cherokee Nation | Current |
Accepting new patients | |
| Cherokee Nation | Current |
Accepting new patients | |
| Cherokee Nation | Current | Accepting new patients |
Locations
859 E Melton Dr
Jay, OK 74346
Phone (918) 253-4271
1001 S 41st St E
#3
Muskogee, OK 74403
Phone (918) 687-0201
900 N Owen Walters Blvd
Salina, OK 74365
Phone (918) 434-8500
100 S Bliss Ave
Tahlequah, OK 74464
Phone (918) 458-3100
19600 E Ross St
Tahlequah, OK 74464
Phone (539) 234-1000
Dept 2269
Tulsa, OK 74182
27371 S 4410 Rd
Vinita, OK 74301
Phone (918) 256-4800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD3670 | NM | |
| Endodontics | 1223E0200X | 7098 | OK | |
| General Practice Dentistry | 1223G0001X | DD3670 | NM | |
| Endodontics | 1223E0200X | DD3670 | NM | Yes |
Addresses
Primary practice location
US Hwy 491 North
Shiprock, NM 87420
Mailing address
PO Box 160
Shiprock, NM 87420-0160
Phone (505) 368-6001
Other providers in Shiprock, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.