MEDICARE: DR. JEFFREY ALAN SCAMMAHORN II 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	7069	OK
2	1223G0001X	General Practice Dentistry	7069	OK

General Provider Information

NPI Number	:	1386135002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY ALAN SCAMMAHORN II DDS

Provider Business Mailing Address
First Line	:	500 HASSWELL DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-7706
Country	:	US
Telephone Number	:	405-317-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	11521 S WESTERN AVE STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5883
Country	:	US
Telephone Number	:	405-692-5800
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	11/23/2021

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