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DR. PRESTON ALLEN MERCURIUS BANOUB DMD
NPI 1578138376
Dentist - Oral and Maxillofacial Surgery in Ardmore, OK

Active since May 24, 2021PECOS Enrolled
2730 12TH AVE NW, ARDMORE, OK 73401(580) 226-0010 Get Directions Write a Review

NPPES record last updated: June 23, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 23, 2025, May 24, 2021 (2 updates tracked since 2021).

About Dr. Preston Allen Mercurius Banoub Dmd NPPES

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

DR. PRESTON ALLEN MERCURIUS BANOUB DMD (NPI 1578138376) is an individual oral and maxillofacial surgery provider in Ardmore, Oklahoma, licensed in Oklahoma (25506) and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS and maintains 7 additional practice locations.

NPPES Registry Identity

NPI1578138376
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. PRESTON ALLEN MERCURIUS BANOUBCredential: DMD
Location Address2730 12TH AVE NWArdmore, OK 73401-1271
Mailing Address6447 Riverdale LnGreendale, WI 53129-2853 · (262) 271-2571
Phone(580) 226-0010
Sole ProprietorYes
Enumeration DateMay 24, 2021
Last NPPES UpdateJune 23, 20252 updates tracked since enumeration
NPPES CertifiedJune 23, 2025
✔ NPI 1578138376 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in OK · 25506
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
2730 12TH AVE NW, Ardmore, OK 73401
Open in Google Maps ↗

Secondary Practice Locations 7

Location 11758 NW 82nd StLawton, OK 73505-2356 · Phone (580) 354-7223 ext. 2
Location 21683 24th Ave NWNorman, OK 73069-6566 · Phone (405) 253-2253 ext. 2
Location 32123 W Memorial RdOklahoma City, OK 73134-8013 · Phone (405) 415-1420 ext. 2
Location 46400 SW 3rd St Ste BOklahoma City, OK 73128-2209 · Phone (405) 416-2357 ext. 2
Location 52307 N Perkins RdStillwater, OK 74075-2234 · Phone (405) 780-4544 ext. 2
Location 665 Jefferson AveElizabeth, NJ 07201-2474 · Phone (908) 367-7712
Location 766 Somme StNewark, NJ 07105-3612 · Phone (973) 221-2567

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Preston Allen Mercurius Banoub Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 73401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$66.48 typical visit price
range $16.68 – $132.40
Typical copayment $16.62 (range $4.17 – $33.10)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

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

DR. JOLECIA HARDIN DDS
Dentist
2730 12TH AVE NW
ARDMORE, OK 73401
Carter County (580) 226-0010
TIANA A EVANS DDS
Dentist
2730 12TH AVE NW
ARDMORE, OK 73401
Carter County (832) 452-7280

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 Preston Banoub's NPI number?

The NPI number for Preston Banoub is 1578138376. It was assigned to this individual provider in the NPPES registry on May 24, 2021.

Where is Preston Banoub located?

Preston Banoub practices at 2730 12th Ave NW, Ardmore, OK 73401. The listed phone number is (580) 226-0010.

What is Preston Banoub's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Preston Banoub enrolled in Medicare?

Yes. Preston Banoub is registered in the Medicare PECOS enrollment system.

What insurance does Preston Banoub accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 12 other insurers list Preston Banoub as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Preston Banoub was last updated on June 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.