Provider Demographics
NPI:1467565861
Name:SCOTT, SHAWN M (DDS)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
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 272
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-0272
Mailing Address - Country:US
Mailing Address - Phone:580-658-5464
Mailing Address - Fax:580-658-5463
Practice Address - Street 1:1919 S. HWY 81
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055
Practice Address - Country:US
Practice Address - Phone:580-658-5464
Practice Address - Fax:580-658-5463
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK55571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-1131842003OtherBCBS OF OK PROVIDER ID