Provider Demographics
NPI:1962564765
Name:SCOTT, CHARLES TIMOTHY (DDS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:TIMOTHY
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 RICHMOND SQ
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2058
Mailing Address - Country:US
Mailing Address - Phone:405-840-5600
Mailing Address - Fax:405-842-9954
Practice Address - Street 1:5225 SE 15TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4513
Practice Address - Country:US
Practice Address - Phone:405-670-2461
Practice Address - Fax:405-842-9954
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice