Healthcare Provider Details

I. General information

NPI: 1063359693
Provider Name (Legal Business Name): ON THE CUSP STILLWATER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S SANGRE RD
STILLWATER OK
74074-1832
US

IV. Provider business mailing address

8222 E 103RD ST STE 133
TULSA OK
74133-7027
US

V. Phone/Fax

Practice location:
  • Phone: 918-970-4944
  • Fax: 918-970-4953
Mailing address:
  • Phone: 918-970-4944
  • Fax: 918-970-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN ROBERTS
Title or Position: OWNER/MEMBER
Credential: DDS,MS
Phone: 918-970-4944