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General NPI Number Information
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NPI Number | 1306317581
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND COSMETIC CENTER OF OKLAHOMA, P.L.L.C.
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 3580 RC LUTTRELL DR STE 102
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City | NORMAN
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State | OK
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Zip | 73072-9702
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Country | US
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Telephone | 405-701-9073
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Fax | 405-310-8708
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Provider Business Mailing Address
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Address Line | 5355 RETREAT CIR
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City | LONGMONT
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State | CO
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Zip | 80503-7627
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Country | US
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Telephone | 405-701-9073
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESSICA NICOLE DOTY
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Credential | MD
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Telephone | 405-701-9073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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