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

Restore Dermatology Clinic LLC

Organization Dermatology Physician · NPI 1336002302

Restore Dermatology Clinic LLC is a Dermatology Physician in Broken Arrow, Oklahoma. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4700 W Urbana St Ste 100
Broken Arrow, OK 74012-5520
Phone: (539) 281-3101
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1336002302
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jessica Graves — Sole Member · (539) 281-3101
NPI enumeratedDecember 6, 2025
Last updated in NPPESDecember 17, 2025
Certification dateDecember 17, 2025
Mailing address4700 W Urbana St Ste 100, Broken Arrow, OK 74012-5520

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