Restore Dermatology Clinic LLC
NPI 1336002302 · Dermatology Physician · Broken Arrow, OK
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Restore Dermatology Clinic LLC is a Dermatology Physician organization in Broken Arrow, OK (NPI 1336002302).
Provider details
- NPI number
- 1336002302
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jessica Graves, Sole Member(539) 281-3101
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2025-12-06
- Last updated
- 2025-12-17
- Certified
- 2025-12-17
Frequently asked questions
- What is Restore Dermatology Clinic LLC's NPI number?
- Restore Dermatology Clinic LLC's National Provider Identifier (NPI) is 1336002302, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Restore Dermatology Clinic LLC?
- Restore Dermatology Clinic LLC is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Restore Dermatology Clinic LLC located?
- Restore Dermatology Clinic LLC's practice location on file with NPPES is 4700 W Urbana St Ste 100, Broken Arrow, OK 74012-5520.
- What is Restore Dermatology Clinic LLC's phone number?
- The practice phone number listed in the NPPES registry for Restore Dermatology Clinic LLC is (539) 281-3101.
- Does Restore Dermatology Clinic LLC accept Medicare?
- Restore Dermatology Clinic LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Restore Dermatology Clinic LLC?
- The authorized official listed on Restore Dermatology Clinic LLC's NPPES record is Jessica Graves, Sole Member. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Restore Dermatology Clinic LLC's NPI active?
- Yes — Restore Dermatology Clinic LLC's NPI (1336002302) is active in the NPPES registry as of the last update on 2025-12-17.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.