COFFEE CREEK FAMILY DENTISTRY (NPI# 1629543251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629543251 |
| Entity Type | Organization |
| Organization Name | COFFEE CREEK FAMILY DENTISTRY |
| Practice Address |
775 W Covell Rd Ste 160 Edmond OK 73003-2302 |
| Practice Telephone | 4058446333 |
| Mailing Telephone | 4058446333 |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2018-10-10 |
| Authorized Official Name | MACK T. RUDD (OWNER) |
| Authorized Official Telephone | 4058446333 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
775 W COVELL RD STE 160 |
| City | EDMOND |
| State | OK |
| Zip Code | 73003-2302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497247860 | Preston Eugene Harraman | Dentist | 775 W Covell Rd Ste 160, Edmond, OK 73003-2302 | 2018-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945202 | Korbin Hally | Dentist | 2600 Tayler Street, Edmond, OK 73003 | 2020-06-04 |
| 1003448325 | Diagnostic Resources, LLC | Physical Medicine & Rehabilitation | 1641 Saratoga Way, Edmond, OK 73003 | 2020-02-05 |
| 1861904021 | Rhonda Diane Pennington | Occupational Therapist | 515 S Santa Fe Ave Ste 103, Edmond, OK 73003 | 2017-10-27 |
| 1588173744 | Hpc Holdings LLC | Clinic/Center | 813 W Covell Rd, Edmond, OK 73003 | 2017-09-20 |
| 1194243568 | Nightengale Chiropractic, LLC | Chiropractor | 2616 Covell Village Dr Ste. 120, Edmond, OK 73003 | 2017-09-06 |
| 1104274927 | Bonsu Osei Asibey | Case Manager/Care Coordinator | 1301 Craig Blvd, Edmond, OK 73003 | 2016-06-02 |
| 1215390810 | Prince Yebo | Case Manager/Care Coordinator | 1817 Redland Dr, Edmond, OK 73003 | 2016-03-31 |
| 1548621691 | Charles Loftis | Physical Therapist | 1321 Fretz Drive, 100, Edmond, OK 73003 | 2016-03-17 |
| 1487013801 | Courage Counseling Center | Community/Behavioral Health | 1400 S. Fretz Ave, Suite 1400, Edmond, OK 73003 | 2016-02-12 |
| 1669889887 | Shannon Gogel | Occupational Therapy Assistant | 1309 Val Genes Rd, Edmond, OK 73003 | 2014-07-21 |
| Find all providers in zip 73003 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174168678 | North Park Family Dental | Clinic/Center | 301 S Boulevard Ste 118, Edmond, OK 73034-3880 | 2019-11-08 |
| 1306304308 | Smileworx Dental | Clinic/Center | 13912 N Western Ave, Edmond, OK 73013-1792 | 2019-03-08 |
| 1386284552 | Dental Surgery Center of Edmond | Clinic/Center | 13912 N Western Ave, Edmond, OK 73013-1792 | 2020-01-15 |
| 1487293270 | Edmond Dentistry & Braces | Clinic/Center | 13912 N Western Ave, Edmond, OK 73013-1792 | 2019-12-27 |
| 1437701851 | Brian B Howell Dds Pllc | Clinic/Center | 1400 E 9th St, Edmond, OK 73034-5701 | 2019-07-15 |
| 1275773715 | Steffen and Farrow Orthodontics Pllc | Clinic/Center | 1601 S Boulevard St, Edmond, OK 73013-5143 | 2009-02-24 |
| 1104098334 | James E. Farley, D.d.s., Inc. | Clinic/Center | 216 E 10th Street Plz, Edmond, OK 73034-4737 | 2008-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609474758 | Sand Springs Dentistry and Braces | Clinic/Center | 152 W. Alexander Blvd, Ste E, Sand Springs, OK 74063 | 2020-10-12 |
| 1831796580 | Perry Smiles LLC | Clinic/Center | 505 N 14th St Ste B, Perry, OK 73077-5000 | 2020-10-06 |
| 1518578095 | Summer Dental Midwest City, Pllc | Clinic/Center | 1900 S Air Depot Blvd Ste 1, Midwest City, OK 73110-5522 | 2020-08-10 |
| 1922626639 | Dental Lodge of Purcell | Clinic/Center | 1929 S Green Ave, Purcell, OK 73080-6203 | 2020-07-09 |
| 1821616533 | Enhance Dental of Norman | Clinic/Center | 1049 12th Ave Ne # 100, Norman, OK 73071-5312 | 2020-07-09 |
| 1164049185 | Custom Dental of Yukon, Pllc | Clinic/Center | 4425 Grant Blvd, Yukon, OK 73099 | 2020-06-26 |
| 1720600174 | Piedmont Dentistry & Braces | Clinic/Center | 12000 Nw Expressway, Yukon, OK 73099 | 2020-05-08 |
| 1073135588 | Yukon Dentistry & Braces | Clinic/Center | 901 E Main Street, Suite 100, Yukon, OK 73099 | 2020-05-07 |
| 1265052062 | Ada Dentistry and Braces | Clinic/Center | 931 Arlington St Ste 3, Ada, OK 74820-4025 | 2020-04-21 |
| 1225657133 | Impressions Dental of Harrah | Clinic/Center | 20926 Se 29th St Ste A, Harrah, OK 73045-6610 | 2020-04-10 |
| 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.