Provider Demographics
NPI:1619969763
Name:MCCASKILL, JIMMY DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:DEAN
Last Name:MCCASKILL
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 1:2510 TEE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6379
Mailing Address - Country:US
Mailing Address - Phone:405-447-4400
Mailing Address - Fax:405-447-4449
Practice Address - Street 1:2510 TEE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6379
Practice Address - Country:US
Practice Address - Phone:405-447-4400
Practice Address - Fax:405-447-4449
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6-52371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice