Provider Demographics
NPI:1447399985
Name:WAUGH, WALTER SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:SCOTT
Last Name:WAUGH
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:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-1459
Mailing Address - Country:US
Mailing Address - Phone:405-341-6134
Mailing Address - Fax:405-341-5164
Practice Address - Street 1:233 E 10TH STREET PLZ
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4737
Practice Address - Country:US
Practice Address - Phone:405-341-6134
Practice Address - Fax:405-341-5164
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice