Healthcare Provider Details

I. General information

NPI: 1467397463
Provider Name (Legal Business Name): SCOTT WESLEY WILLIAMS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

1308 NW 171ST ST
EDMOND OK
73012-7420
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7744
  • Fax:
Mailing address:
  • Phone: 405-512-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberSTUDENT
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: