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Active NPI 1295628659 Individual Practitioner Male Practitioner

Cody Duc Van

Dentist - General Practice • Broken Arrow, OK

Professional Overview & Biography Verified Profile Summary

Cody Van is a registered healthcare professional specializing in Dentist - General Practice in Broken Arrow, OK. Practice services are available at 1950 W KENOSHA ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1950 W Kenosha St

Broken Arrow, OK 740128944

Telephone 9185181526
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Broken Arrow, OK

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 17.8 Yrs
Regional Practice Density
39 Specialists

Practicing in Broken Arrow, OK (1496 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-06-02
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License OK 8055

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Dr. Tyler Rolland , DDS

Dentist - General Practice

NPI 1154996601

Doctor of Dental Surgery

Dr. Rachel Young , DMD

Dentist - General Practice

NPI 1285201350

Doctor of Dental Medicine

Dr. Daniel Keesh , DDS

Dentist - General Practice

NPI 1659063923

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active June 02, 2025

NPI status registered as active in NPPES database

📍
Updated Practice Location June 02, 2025

Registered at 1950 W KENOSHA ST, BROKEN ARROW, OK 740128944 (Tel: 9185181526)

📍
Updated Business Mailing Address June 02, 2025

Registered at 2219 E 11TH ST UNIT 204, TULSA, OK 741043641 (Tel: 3166809288)

👤
Provider Name / Credentials Updated June 02, 2025

Recorded as CODY VAN

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 02, 2025

Dentist (License #8055 in OK)

🟢
Initial NPI Registration & Enumeration June 02, 2025

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1295628659
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 02, 2025
Last Update: June 02, 2025
Sole Proprietor: Yes

Mailing Address

2219 E 11th St Unit 204

Tulsa, OK 741043641

Phone: 3166809288

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.