Restore Dermatology Clinic LLC
NPI 1336002302ActiveOrganization· Dermatology· Broken Arrow, OK
Dermatology in Broken Arrow, Oklahoma, registered in NPPES in December 2025. The authorized official on file is Jessica Graves, PA-C, Sole Member. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1336002302 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 6, 2025 |
| Last updated in NPPES | Dec 17, 2025 |
| Certified by provider | Dec 17, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (OK) |
|---|
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