DENTAL SPECIALISTS OF EDMOND (NPI# 1699395343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699395343 |
| Entity Type | Organization |
| Organization Name | DENTAL SPECIALISTS OF EDMOND |
| Practice Address |
16430 Muirfield Pl Edmond OK 73013 |
| Mailing Address |
17705 Sparrow Hawk Ln Edmond OK 73012-7137 |
| Practice Telephone | 4056960908 |
| Mailing Telephone | 4055106853 |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2020-04-23 |
| Authorized Official Name | DR. YACOUB AL SAKKA (CO-OWNER) |
| Authorized Official Telephone | 4056960908 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers | ||
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | PROVIDER 01 | 1568862357 | 01 |
| OK | PROVIDER 02 | 1497023196 | 01 |
| Street Address |
16430 MUIRFIELD PL |
| City | EDMOND |
| State | OK |
| Zip Code | 73013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| 1396279808 | Teal Creek Life Care Community Inc | Assisted Living Facility | 13501 N. Bryant Ave., Edmond, OK 73013 | 2017-04-12 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588218143 | Niranjan Joshi | Dentist | 1201 N Stonewall Ave Ste 494, Oklahoma City, OK 73117-1214 | 2019-07-31 |
| 1811103229 | Bryce C. Dorrough | Dentist | 8301 S Walker Ave, Oklahoma City, OK 73139-9419 | 2007-05-15 |
| 1669693347 | Daniel Edward Bates | Dentist | 652 Hamilton Rd., Usa Dental Activity, Fort Sill, OK 73503 | 2007-05-01 |
| 1275750184 | Roman Michael Lobodiak | Dentist | 3232 E 31st St, Tulsa, OK 74105-2442 | 2007-04-20 |
| 1750406237 | James Robert Reneau | Dentist | 2751 Nw Expressway St, Suite 5, Oklahoma City, OK 73112-7084 | 2007-03-21 |
| 1366500142 | Mark William Balenseifen | Dentist | 7509 Nw 23rd St, Bethany, OK 73008-4941 | 2006-12-05 |
| 1932199486 | Ernest L Dabreo | Dentist | 72d Medical Group, 1094 Air Depot Blvd, Tinker Afb, OK 73130 | 2005-10-26 |
| 1568862357 | Yacoub Al Sakka | Dentist | 1201 N Stonewall Ave, Oklahoma City, OK 73117-1214 | 2014-08-28 |
| 1124441530 | Eswar Keran C Damodara | Dentist | 1201 N Stonewall Ave, Rm# 535a, Oklahoma City, OK 73117-1214 | 2014-01-22 |
| 1154659308 | John D. Mose | Dentist | 2909 Azalea Park Dr, Muskogee, OK 74401-2283 | 2009-11-30 |
| Find all providers with the same taxonomy | ||||
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| 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.