1. Home
  2. Directory
  3. Oklahoma
  4. City
  5. Dentist
  6. NPI Profile

CUSTOM DENTAL OF EDMOND, PLLC
NPI 1013211846
Dentist - General Practice in Oklahoma City, OK

Active since January 10, 2011
17840 N. PENN, OKLAHOMA CITY, OK 73012(405) 282-6440(405) 282-6785 Get Directions Write a Review

NPPES record last updated: September 15, 2011. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Custom Dental Of Edmond, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CUSTOM DENTAL OF EDMOND, PLLC (NPI 1013211846) is a healthcare organization registered as a general practice in Oklahoma City, Oklahoma and active in the NPI registry since January 2011. The organization lists Grant Pitt, Dentist, as its authorized official.

NPPES Registry Identity

NPI1013211846
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameCUSTOM DENTAL OF EDMOND, PLLC
Location Address17840 N. PENNOklahoma City, OK 73012
Mailing Address17840 N Pennsylvania AveEdmond, OK 73012-9097 · (405) 282-6440 · Fax (405) 282-6785
Phone(405) 282-6440
Fax(405) 282-6785
Organization SubpartNo
Authorized OfficialGrant PittDentist · (405) 282-6440
Enumeration DateJanuary 10, 2011
Last NPPES UpdateSeptember 15, 2011
✔ NPI 1013211846 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in OK · 5978
Definition
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.
17840 N. PENN, Oklahoma City, OK 73012
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Custom Dental Of Edmond, PLLC's NPI number?

The NPI number for Custom Dental Of Edmond, PLLC is 1013211846. It was assigned to this organization in the NPPES registry on January 10, 2011.

Where is Custom Dental Of Edmond, PLLC located?

Custom Dental Of Edmond, PLLC is located at 17840 N. Penn, Oklahoma City, OK 73012. The listed phone number is (405) 282-6440.

What is Custom Dental Of Edmond, PLLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Custom Dental Of Edmond, PLLC was last updated on September 15, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.