MEDICARE: PAXTON MCCAMMON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7553	OK

General Provider Information

NPI Number	:	1205574597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAXTON MCCAMMON DDS

Provider Business Mailing Address
First Line	:	400 RIVERWALK TER STE 250
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-5619
Country	:	US
Telephone Number	:	918-998-0996
Fax Number	:	918-235-9079

Provider Business Practice Location Address
First Line	:	1111 W MAIN ST
Second Line	:
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-3112
Country	:	US
Telephone Number	:	918-371-3375
Fax Number	:	918-371-4407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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