The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, “Does your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Compared with the same specialty in Owasso and Oklahoma

15 active clinicians are listed under Dentist - General Practice with a practice address in Owasso, OK (1,400 in Oklahoma).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Owasso

0% of these 15 clinicians have the CMS telehealth indicator.

0% of these 15 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo · Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-05-29

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

License # reported to NPPES OK 8083

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Oklahoma State Board of Medical Licensure.

Look Up on State Board Site

Career & Practice History

NPI enumerated May 13, 2025.

No changes to the name, practice address, taxonomy or NPI status in this record have been observed in the monthly NPPES data files from June 2025 to August 2026.

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NPI Administrative Meta

NPI Number: 1407647159

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 13, 2025

Last Update: May 29, 2025

Sole Proprietor: Yes

Update or Correct Profile

Other Dentist - General Practices in Owasso

All Dentist - General Practices in Owasso

Mailing Address

12006 E 108th St N

Owasso, OK 740551008

Phone: 8623240687

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.