Healthcare Provider Details

I. General information

NPI: 1205574597
Provider Name (Legal Business Name): PAXTON MCCAMMON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 S MEMORIAL DR STE A
TULSA OK
74145-9009
US

IV. Provider business mailing address

5404 S MEMORIAL DR STE A
TULSA OK
74145-9009
US

V. Phone/Fax

Practice location:
  • Phone: 918-663-5215
  • Fax: 918-663-7030
Mailing address:
  • Phone: 918-663-5215
  • Fax: 918-663-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7553
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: