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General NPI Number Information
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NPI Number | 1508905068
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Entity Type | Organization
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Legal Business Name | EDMOND FAMILY DENTAL DESIGNS
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 233 E 10TH STREET PLZ
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City | EDMOND
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State | OK
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Zip | 73034-4737
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Country | US
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Telephone | 405-341-6134
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Fax | 405-341-5164
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Provider Business Mailing Address
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Address Line | PO BOX 1459
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City | EDMOND
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State | OK
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Zip | 73083-1459
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Country | US
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Telephone | 405-341-6134
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Fax | 405-341-5164
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Authorized Official
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Title or Position | GENERAL DENSTIST
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Name | DR. W. SCOTT WAUGH
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Credential | D.D.S.
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Telephone | 405-341-6134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3653
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License Number State | OK
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