Healthcare Provider Details

I. General information

NPI: 1801909221
Provider Name (Legal Business Name): SCOTT FAMILY DENTISTRY, INC. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S. HWY 81
MARLOW OK
73055
US

IV. Provider business mailing address

PO BOX 272
MARLOW OK
73055-0272
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-5464
  • Fax: 580-658-5463
Mailing address:
  • Phone: 580-658-5464
  • Fax: 580-658-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3781
License Number StateOK

VIII. Authorized Official

Name: BRUCE E SCOTT
Title or Position: SOLE PROPRIETOR
Credential: DDS
Phone: 580-658-5464