Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Custom Dental of Edmond, PLLC

Organization General Practice Dentistry · NPI 1013211846

Custom Dental of Edmond, PLLC is a General Practice Dentistry in Oklahoma City, Oklahoma. Licensed in Oklahoma. Registered with an NPI since 2011.

Licensed in
OK
In the registry since
2011
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

17840 N Penn
Oklahoma City, OK 73012
Phone: (405) 282-6440
Fax: (405) 282-6785
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 5978 (OK)

Record details

NPI number1013211846
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Grant Pitt — Dentist · (405) 282-6440
NPI enumeratedJanuary 10, 2011
Last updated in NPPESSeptember 15, 2011
Mailing address17840 N Pennsylvania Ave, Edmond, OK 73012-9097

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