MEDICARE: SHEILA GRISWOLD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7163	OK

General Provider Information

NPI Number	:	1366000812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA GRISWOLD DDS

Provider Business Mailing Address
First Line	:	2328 S 4TH ST
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-6804
Country	:	US
Telephone Number	:	405-286-9088
Fax Number	:

Provider Business Practice Location Address
First Line	:	4107 N COUNCIL RD STE F
Second Line	:
City	:	BETHANY
State	:	OK
Zip	:	73008-3131
Country	:	US
Telephone Number	:	405-286-9088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	04/17/2025

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