Healthcare Provider Details

I. General information

NPI: 1265690192
Provider Name (Legal Business Name): S. SCOTT LASTER, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E. COMMERCIAL
INOLA OK
74036
US

IV. Provider business mailing address

PO BOX 99
INOLA OK
74036-0099
US

V. Phone/Fax

Practice location:
  • Phone: 918-369-4300
  • Fax: 918-369-6440
Mailing address:
  • Phone: 918-369-4300
  • Fax: 918-369-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5021
License Number StateOK

VIII. Authorized Official

Name: DR. S SCOTT LASTER
Title or Position: DENTIST/ PRESIDENT
Credential:
Phone: 918-369-4300