DENTAL WORKS Full NPI Record 1003003831
Dentist - General Practice in Oklahoma City, OK
Complete NPI Dataset
The following table represents the complete NPI 1003003831 dataset for Dental Works in 4200 HEMINGWAY DR OKLAHOMA CITY, OK 73118. The data table includes a list of all field names, values and definitions of the complete NPI record. The NPI dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.
| Name | Value | Definition |
|---|---|---|
| NPI | 1003003831 | Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Entity Type Code | 2 | Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Employer Identification Number EIN | UNAVAIL | |
| Provider Organization Name Legal Business Name | EDWINA V. JOHNSON, D.D.S., P.C. | Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Provider Other Organization Name | DENTAL WORKS | Other name by which the organization provider is or has been known. |
| Provider Other Organization Name Type Code | 3 | Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
| Provider First Line Business Mailing Address | 4200 HEMINGWAY DR | The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’. |
| Provider Business Mailing Address City Name | OKLAHOMA CITY | The city name in the mailing address of the provider being identified. |
| Provider Business Mailing Address State Name | OK | The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’. |
| Provider Business Mailing Address Postal Code | 731182235 | The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’. |
| Provider Business Mailing Address Country Code If outside U S | US | The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’. |
| Provider Business Mailing Address Telephone Number | 4055571245 | The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’. |
| Provider First Line Business Practice Location Address | 4200 HEMINGWAY DR | The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Business Practice Location Address City Name | OKLAHOMA CITY | The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name | OK | The State code in the location of the provider being identified. |
| Provider Business Practice Location Address Postal Code | 731182235 | The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address Country Code If outside U S | US | The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number | 4055571245 | The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date | 9/25/2007 | The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date | 6/18/2008 | The date that a record was last updated or changed. |
| Authorized Official Last Name | JOHNSON | The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name | EDWINA | The first name of the authorized official. |
| Authorized Official Middle Name | VIRGINIA | The middle name of the authorized official. |
| Authorized Official Title or Position | DENTIST | The title or position of the authorized official. |
| Authorized Official Telephone Number | 4055571245 | The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 | 1223G0001X | Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider License Number 1 | S 4606 | The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 | OK | The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 1 | Y | |
| Other Provider Identifier 1 | 1316049141 | Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 1 | 01 | Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 1 | OK | |
| Other Provider Identifier Issuer 1 | NPI INDIVIDUAL ID | |
| Other Provider Identifier 2 | ========= | Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 2 | 01 | Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 2 | OK | |
| Other Provider Identifier Issuer 2 | TAX ID | |
| Other Provider Identifier 3 | 731231901001 | Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier Type Code 3 | 01 | Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Other Provider Identifier State 3 | OK | |
| Other Provider Identifier Issuer 3 | OTHER ID OK | |
| Is Organization Subpart | N | |
| Authorized Official Name Prefix Text | MS. | |
| Authorized Official Credential Text | D.D.S. | |
| Healthcare Provider Taxonomy Group 1 | 193400000X SINGLE SPECIALTY GROUP | |