MEDICARE: JENNIFER ESCOBAR

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	1223G0001X	General Practice Dentistry	8030	OK

General Provider Information

NPI Number	:	1740173269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ESCOBAR

Provider Business Mailing Address
First Line	:	9501 N COUNTYLINE RD
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-8353
Country	:	US
Telephone Number	:	405-568-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	8811 E RENO AVE STE 103
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7726
Country	:	US
Telephone Number	:	405-732-2660
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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Directions to “ JENNIFER ESCOBAR ” Practice Location

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