CUSTOM DENTAL OF OWASSO, PLLC (NPI# 1659689248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659689248 |
| Entity Type | Organization |
| Organization Name | CUSTOM DENTAL OF OWASSO, PLLC |
| Practice Address |
11501 N. 135th East Ave Owasso OK 74055 |
| Mailing Address |
2001 S Division St Guthrie OK 73044-6063 |
| Practice Telephone | 9183717645 |
| Practice Fax Number | 9183717272 |
| Mailing Telephone | 4052826440 |
| Mailing Fax Number | 4052826785 |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2010-09-17 |
| Authorized Official Name | DR. RON CAMPBELL (DENTIST) |
| Authorized Official Telephone | 9183717645 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 6099 | OK | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | CUSTOM DENTAL OF OWASSO, PLLC | 11501 N 135th E Ave, Owasso, OK 74055 |
| Street Address |
11501 N. 135TH EAST AVE |
| City | OWASSO |
| State | OK |
| Zip Code | 74055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972151587 | Lakecrest Dental-owasso 96th | Dentist | 9551 N. Owasso Expressway, Suite #100, Owasso, OK 74055 | 2019-08-27 |
| 1205328697 | Eddie Duane Gaut | Case Manager/Care Coordinator | 110 W 3rd St., Apt 11, Owasso, OK 74055 | 2018-06-01 |
| 1821586694 | Kaitlyn Konarik | Speech-Language Pathologist | 12899 E 76th St N, Ste. 109, Owasso, OH 74055 | 2018-04-27 |
| 1043733769 | Kelsey Renae Nicklas | Case Manager/Care Coordinator | 9310 N 163rd East Ave, Owasso, OK 74055 | 2017-07-25 |
| 1700259256 | Genscripts Owasso, LLC | Pharmacy | 9538 N Garnett Rd, Suite 102, Owasso, OK 74055 | 2015-11-05 |
| 1770968810 | Premier Anesthesia Management Inc | Clinic/Center | 19236 E Twin Creeks Dr, Owasso, OK 74055 | 2015-07-29 |
| 1598152407 | Justin Lum | Physical Therapist | 12326 E 86th St N, Owasso, OK 74055 | 2015-04-17 |
| 1033507660 | Kimberly Louise Howard | Physical Therapy Assistant | 12899 East 76th St North, Owasso, OK 74055 | 2015-01-06 |
| 1780920629 | Timothy Ryan Thornton | Behavioral Analyst | 11330 N 94 E Ave, Owasso, OK 74055 | 2012-12-21 |
| 1679842785 | Kelli Marie Ellis | Counselor | 19760 E Fox Run Cir, Owasso, OK 74055 | 2011-12-19 |
| Find all providers in zip 74055 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295264752 | Kristina Vadimovna Rogozhkina | Dentist | 9551 N Owasso Expy # 100, Owasso, OK 74055-5414 | 2017-06-08 |
| 1386091908 | Ali Somjee | Dentist | 13101 E 96th St N, Owasso, OK 74055-4767 | 2016-05-24 |
| 1356741508 | Ruchira Lalwani | Dentist | 10732 N 146th East Ave, Owasso, OK 74055-5990 | 2014-08-25 |
| 1811339880 | Yvonne Safo-kwakye | Dentist | 9025 N 121st East Ave, Owasso, OK 74055-5398 | 2013-07-19 |
| 1073704904 | Matthew Philip Gray | Dentist | 11920 E 86th St N, Owasso, OK 74055 | 2007-08-06 |
| 1043224231 | Mark Alan Curtis | Dentist | 9050 N Garnett Rd, Owasso, OK 74055-4435 | 2006-07-27 |
| 1487670428 | Mark Argo | Dentist | 8500 N 129th East Ave, Owasso, OK 74055-2162 | 2006-07-14 |
| 1669452421 | Matthew Chad Stephens | Dentist | 13109 E 95th Ct N, Owasso, OK 74055-4722 | 2006-01-18 |
| 1629060975 | Owasso Family Denistry | Dentist | 8801 N 145th East Ave, Owasso, OK 74055-8464 | 2005-08-22 |
| 1851742589 | Jillian Renae Prather | Dentist | 12814 E 101st Pl N, #101, Owasso, OK 74055-4662 | 2016-06-23 |
| Find all providers in OWASSO | ||||
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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.