Healthcare Provider Details

I. General information

NPI: 1306317581
Provider Name (Legal Business Name): DERMATOLOGY AND COSMETIC CENTER OF OKLAHOMA, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 RC LUTTRELL DR STE 102
NORMAN OK
73072-9702
US

IV. Provider business mailing address

3580 RC LUTTRELL DR STE 102
NORMAN OK
73072-9736
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-9073
  • Fax: 405-310-8708
Mailing address:
  • Phone: 405-928-6100
  • Fax: 405-928-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA NICOLE DOTY
Title or Position: PRESIDENT
Credential: MD
Phone: 405-701-9073