Provider Demographics
NPI:1700303328
Name:PRESCOTT, JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 LONE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4291
Mailing Address - Country:US
Mailing Address - Phone:405-684-3203
Mailing Address - Fax:
Practice Address - Street 1:1060 SW 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2494
Practice Address - Country:US
Practice Address - Phone:405-494-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK70001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice