MEDICARE: DR. MATTHEW KEITH SAXON D.D.S.

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	1223P0300X	Periodontics	93	OK
2	1223P0300X	Periodontics	33125	TX

General Provider Information

NPI Number	:	1710413794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW KEITH SAXON D.D.S.

Provider Business Mailing Address
First Line	:	4545 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2905
Country	:	US
Telephone Number	:	918-749-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 S HARVARD AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2905
Country	:	US
Telephone Number	:	918-749-1850
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	04/18/2024

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