Provider Demographics
NPI:1063900066
Name:SCOTT, CHRISTOPHER ALLEN (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HWY # U-63
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:650-814-7139
Mailing Address - Fax:
Practice Address - Street 1:1201 N STONEWALL AVE STE 230
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-4441
Practice Address - Fax:405-271-1134
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7903122300000X
390200000X
OK2481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program