GUSTAVO LAWRENCE GOVIN III (NPI# 1710093570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710093570 |
| Entity Type | Individual |
| Full Name | GUSTAVO LAWRENCE GOVIN III |
| Credential | DDS MS |
| Practice Address |
18 Dunloup Shawnee OK 74804 |
| Practice Telephone | 4052751252 |
| Practice Fax Number | 4052754292 |
| Mailing Telephone | 4052751252 |
| Mailing Fax Number | 4052754292 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
3739 | OK | Dental Providers |
| Street Address |
18 DUNLOUP |
| City | SHAWNEE |
| State | OK |
| Zip Code | 74804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164063699 | Isaac Benjamin Gray | Student in an Organized Health Care Education/Training Program | 4010 Blaine Road, Shawnee, OK 74804 | 2019-10-06 |
| 1750863775 | Dillon Gibson | Specialist/Technologist | Oklahoma Baptist University, 500 W. University, Shawnee, OK 74804 | 2018-09-06 |
| 1912368242 | Peggy Baker | Occupational Therapist | 7602 N. Kickapoo, Shawnee, OK 74804 | 2016-03-15 |
| 1861731093 | Shariff Mohammed El-assi | Behavioral Analyst | 45 Crown Point, Shawnee, OK 74804 | 2013-02-07 |
| 1902103112 | Action Physical Therapy & Rehabilitation, Pllc | Physical Therapist | 2506 N Harrison, Shawnee, OK 74804 | 2011-02-24 |
| 1639493315 | Oklahoma Em - 1 Medical Services,p.c. | Emergency Medicine | 1102 W.macarthur, Shawnee, OK 74804 | 2010-03-24 |
| 1790989473 | Eastern Oklahoma Radiation Associates, LLC | Radiology | 3700 N Kickapoo Ave Ste 108, Shawnee, OK 74804 | 2007-06-14 |
| 1821210444 | Mickey Sehorn D.d.s., P.C. | Dentist | 1601 Airport Drive, Shawnee, OK 74804 | 2007-05-03 |
| 1760525711 | Leanna Rae Olsen | Registered Nurse | 1500 N. Kickapoo, Suite #4, Shawnee, OK 74804 | 2007-02-15 |
| 1467517920 | Mahmoud Abdel-fattah Khalifa | Pathology | Unity Health Center, 1102 West Macarthur, Shawnee, OK 74804 | 2006-12-26 |
| Find all providers in zip 74804 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801303888 | Wisdom Tooth Center, Pllc | Dentist | 2745 S I 35 Service Rd, Moore, OK 73160-2715 | 2017-12-29 |
| 1033560966 | Medical Consultant Services | Dentist | 3309 W Princeton St, Broken Arrow, OK 74012-9587 | 2016-06-22 |
| 1487019071 | Stonewood Hills Oral Maxillofacial Surgery, Inc. | Dentist | 425 Stone Wood Dr, Broken Arrow, OK 74012-1026 | 2015-12-23 |
| 1477927085 | Justin Pisano | Dentist | 429 Nw 11th St, Apt 6, Oklahoma City, OK 73103-3927 | 2015-11-19 |
| 1558776989 | Daniel Szalay | Dentist | 1201 N Stonewall Ave Ste 206, Oklahoma City, OK 73117-1214 | 2014-06-24 |
| 1558771170 | Yukon Maxillo-facial Surgery Center | Dentist | 404 S Mustang Rd, Yukon, OK 73099-6754 | 2014-05-05 |
| 1649690025 | Andrew Mcgarry | Dentist | 10900 Hefner Pointe Dr Ste 204, Oklahoma City, OK 73120 | 2014-04-23 |
| 1740572601 | Lauren Lunday | Dentist | 3617 W Gore Blvd Ste B, Lawton, OK 73505-6373 | 2011-05-11 |
| 1265735724 | Michael J. Gliddon Dba Live Oak Oral Surgery | Dentist | 1415 Nw 33rd St, Lawton, OK 73505-3806 | 2010-12-06 |
| 1023329901 | Armando Retana | Dentist | 7322 E 91st St, Tulsa, OK 74133-6016 | 2010-06-25 |
| 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.