BOARD OF REGENTS OF OK - COL OF DENTISTRY GRAD PERODONTICS (NPI# 1609142827) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609142827 |
| Entity Type | Organization |
| Organization Name | BOARD OF REGENTS OF OK - COL OF DENTISTRY GRAD PERODONTICS |
| Other Organization Name | COL OF DENTISTRY GRAD |
| Practice Address |
1201 N Stonewall Ave Rm Dcs253 Oklahoma City OK 73117-1214 |
| Mailing Address |
Po Box 26901 Oklahoma City OK 73126-0901 |
| Practice Telephone | 4052716531 |
| Practice Fax Number | 4052712922 |
| Mailing Telephone | 4052716531 |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2012-04-02 |
| Authorized Official Name | LISA ASCH (ASSOCIATE DIRECTOR RESARCH ADMIN) |
| Authorized Official Telephone | 4052712090 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Col of Dentistry Grad | Doing Business As Name - Organization |
| Street Address |
1201 N STONEWALL AVE RM DCS253 |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73117-1214 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922623271 | Katelyn Gerth | Student in an Organized Health Care Education/Training Program | University of Oklahoma College of Medicine, 800 Stanton L. Young Blvd, Oklahoma City, OK 73117 | 2020-06-12 |
| 1114401387 | Northstar Counseling Associates, LLC | Counselor | 4540 E Reno Ave, Del City, OK 73117 | 2018-09-24 |
| 1801300710 | Kenneth Belyeu | Peer Specialist | 625 N Nebraska, Okc, OK 73117 | 2017-11-30 |
| 1215483029 | Brian Behnum Minavi | Dentist | 1201 N. Stonewall Ave., Oklahoma City, OK 73117 | 2016-08-31 |
| 1649631409 | April Ajanwachukwu | Social Worker | 1309 N Nebraska Ave, Oklahoma City, OK 73117 | 2016-03-08 |
| 1518340405 | Shachi Shah | Dentist | 1201 N Stonewall Ave # 544n, Oklahoma City, OK 73117 | 2015-07-09 |
| 1063829067 | Lauren Marie Pierce | Speech-Language Pathologist | 1200 N. Stonewall Ave, Ahb 1058, Oklahoma City, OK 73117 | 2014-07-22 |
| 1306195235 | Rachel Devecchio | Case Manager/Care Coordinator | 1300 Ne 13th St, Oklahoma City, OK 73117 | 2012-09-06 |
| 1265780837 | Tiffany Dawn Stokely | Counselor | 1701 E Park Pl, Oklahoma, OK 73117 | 2012-08-29 |
| 1689935645 | Everett House | Behavioral Analyst | 1100 Ne 15th St, Oklahoma Cituy, OK 73117 | 2012-06-06 |
| Find all providers in zip 73117 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063021343 | Xixi Wu | Dentist | 1201 N Stonewall Ave # 524d, Oklahoma City, OK 73117-1214 | 2020-07-23 |
| 1851713747 | Maria Fernanda Santos Peres | Dentist | 1201 N Stonewall Ave Rm 542, Oklahoma City, OK 73117-1214 | 2014-01-10 |
| 1669614137 | Ryan James Lanman | Dentist | 3621 Nw 63rd St Ste I, Oklahoma City, OK 73116-2041 | 2009-03-30 |
| 1932169224 | Karen K Luce | Dentist | 1201 N. Stonewall Ave, Oklahoma City, OK 73110 | 2006-03-23 |
| 1811999618 | Gregory S Shanbour | Dentist | 8117 S Walker Ave, Oklahoma City, OK 73139-9476 | 2005-08-11 |
| 1255334835 | William George Reeves | Dentist | 2800 Featherstone Rd, Oklahoma City, OK 73120-2151 | 2005-05-27 |
| 1083195267 | Mohammed F Felemban | Dentist | 1201 N Stonewall Ave, Oklahoma City, OK 73117-1214 | 2018-08-24 |
| 1679984587 | Juan Rodriguez | Dentist | 1201 N Stonewall Ave, Oklahoma City, OK 73117-1214 | 2014-05-13 |
| 1144588559 | Gregory Farris Shanbour | Dentist | 8117 S Walker Ave, Oklahoma City, OK 73139-9476 | 2012-04-24 |
| 1598086001 | Jason Daniel Nicholson | Dentist | 2401 Nw 23rd St, Suite 23, Oklahoma City, OK 73107-2442 | 2010-06-18 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73117 |
Please comment or provide details below to improve the information on BOARD OF REGENTS OF OK - COL OF DENTISTRY GRAD PERODONTICS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.