Provider Demographics
NPI:1487393153
Name:SCHOLZ, MIRANDA NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:NICOLE
Last Name:SCHOLZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:NICOLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13318 E 89TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4777
Mailing Address - Country:US
Mailing Address - Phone:479-651-3978
Mailing Address - Fax:
Practice Address - Street 1:5031 E 116TH ST N
Practice Address - Street 2:
Practice Address - City:SPERRY
Practice Address - State:OK
Practice Address - Zip Code:74073-4199
Practice Address - Country:US
Practice Address - Phone:918-288-7695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice