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ACE LOGO
NPI 1669097804
Dentist - General Practice in Enid, OK

Active since June 13, 2020PECOS Enrolled
402 S OAKWOOD RD STE D, ENID, OK 73703(580) 242-5862 Get Directions Write a Review

NPPES record last updated: June 13, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Ace Logo NPPES

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

ACE LOGO (NPI 1669097804) is an individual general practice provider in Enid, Oklahoma, licensed in Oklahoma (7292) and active in the NPI registry since June 2020. He is enrolled in Medicare PECOS and is a graduate of Midwestern University College Of Dental Medicine, Glendale (2020).

NPPES Registry Identity

NPI1669097804
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameACE LOGO
Location Address402 S OAKWOOD RD STE DEnid, OK 73703-4945
Mailing Address402 S Oakwood Rd Ste DEnid, OK 73703-4945 · (580) 242-5862
Phone(580) 242-5862
Sole ProprietorNo
Medical School CMSMidwestern University College Of Dental Medicine, GlendaleGraduated 2020
Enumeration DateJune 13, 2020
NPPES CertifiedJune 13, 2020
✔ NPI 1669097804 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 · 7292
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.
402 S OAKWOOD RD STE D, Enid, OK 73703
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ace Logo is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8123524626
PECOS Enrollment IDI20251002005224
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.

Medicare Billing Reassignment

Medicare enrollment records show Ace Logo reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Dr. Siona Motufau Jr. DDS Co
566 mi
Oral and Maxillofacial Surgery
333 S TOWNSEND AVE
Montrose, CO 81401
  • Reassigned Medicare billing, Colorado enrollment
  • 2 clinicians in this Medicare group
NPI 1962892810 (970) 615-7500

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 73703 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

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

STEVEN C. DURR, D.D.S.
Clinic/Center (Dental)
402 S OAKWOOD RD STE D
ENID, OK 73703
Garfield County (580) 242-5862

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 Ace Logo's NPI number?

The NPI number for Ace Logo is 1669097804. It was assigned to this individual provider in the NPPES registry on June 13, 2020.

Where is Ace Logo located?

Ace Logo practices at 402 S Oakwood Rd Ste D, Enid, OK 73703. The listed phone number is (580) 242-5862.

What is Ace Logo's specialty?

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

Is Ace Logo enrolled in Medicare?

Yes. Ace Logo is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Ace Logo's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ace Logo reassigns Medicare benefits to Dr. Siona Motufau Jr. DDS Co (Montrose, CO). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ace Logo's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Ace Logo accept?

Health plans from Anthem Blue Cross and Blue Shield list Ace Logo 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 Ace Logo was last updated on June 13, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.