1. Home
  2. Directory
  3. Oklahoma
  4. Broken Arrow
  5. Dermatology
  6. NPI Profile

RESTORE DERMATOLOGY CLINIC LLC
NPI 1336002302
Dermatology in Broken Arrow, OK

Active since December 06, 2025
4700 W URBANA ST STE 100, BROKEN ARROW, OK 74012(539) 281-3101 Get Directions Write a Review

NPPES record last updated: December 17, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 17, 2025, Dec 6, 2025 (2 updates tracked since 2025).

About Restore Dermatology Clinic Llc NPPES

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

RESTORE DERMATOLOGY CLINIC LLC (NPI 1336002302) is a healthcare organization registered as a dermatology in Broken Arrow, Oklahoma and active in the NPI registry since December 2025. The organization lists Jessica Graves, Sole Member, as its authorized official.

NPPES Registry Identity

NPI1336002302
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameRESTORE DERMATOLOGY CLINIC LLC
Location Address4700 W URBANA ST STE 100Broken Arrow, OK 74012-5520
Mailing Address4700 W Urbana St Ste 100Broken Arrow, OK 74012-5520 · (539) 281-3101
Phone(539) 281-3101
Organization SubpartNo
Authorized OfficialJessica GravesSole Member · (539) 281-3101
Enumeration DateDecember 6, 2025
Last NPPES UpdateDecember 17, 20252 updates tracked since enumeration
NPPES CertifiedDecember 17, 2025
✔ NPI 1336002302 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
4700 W URBANA ST STE 100, Broken Arrow, OK 74012
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

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JESSICA LAURA GRAVES PA-C
Physician Assistant (Medical)
4700 W URBANA ST STE 100
BROKEN ARROW, OK 74012
Tulsa County (539) 281-3101

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 Restore Dermatology Clinic LLC's NPI number?

The NPI number for Restore Dermatology Clinic LLC is 1336002302. It was assigned to this organization in the NPPES registry on December 6, 2025.

Where is Restore Dermatology Clinic LLC located?

Restore Dermatology Clinic LLC is located at 4700 W Urbana St Ste 100, Broken Arrow, OK 74012. The listed phone number is (539) 281-3101.

What is Restore Dermatology Clinic LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

When was this NPI record last updated?

The NPPES record for Restore Dermatology Clinic LLC was last updated on December 17, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.