NPIMap

Organization Active NPI

Kingfisher Dental PLLC

  • General Practice Dentistry
  • Kingfisher, OK
National Provider Identifier
1992849996
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3767 Issued in OK
Legal business name
KINGFISHER DENTAL PLLC
Practice address
100 Starlite Dr
Kingfisher, OK 73750
Phone
(405) 375-5855
Fax
(405) 358-2946
NPI assigned
Feb 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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

Authorized official

Name
Benjamin James Bowman
Title
Owner
Phone
(405) 375-5855

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 3767 OK Primary

Addresses

Primary practice location

100 Starlite Dr
Kingfisher, OK 73750

Mailing address

9060 Harmony Dr
Ste E
Midwest City, OK 73130
Phone (405) 594-8844

Other identifiers 1

IdentifierTypeStateIssuer
200208490AMedicaidOK

Other names 1

  • Kingfisher Dentistry and Braces Doing business as

National Provider Directory

National Provider Directory

Locations

100 Starlite Dr
Kingfisher, OK 73750
Phone (405) 375-5855

Practitioners & affiliated clinicians

Practitioners 4

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": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613347200000",
    "number": "1992849996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9060 HARMONY DR",
            "address_2": "STE E",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "73130",
            "telephone_number": "405-594-8844",
            "fax_number": "405-485-8043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STARLITE DR",
            "city": "KINGFISHER",
            "state": "OK",
            "postal_code": "73750",
            "telephone_number": "405-375-5855",
            "fax_number": "405-358-2946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGFISHER DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-375-5855"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "3767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200208490A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingfisher Dentistry and Braces",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingfisher, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.