| Andrea Matli Scoville Dds Pc | |
|
601 W 2nd St Watonga OK 73772-2601 | |
| (580) 623-7121 | |
| (580) 623-7124 |
| Full Name | Andrea Matli Scoville Dds Pc |
|---|---|
| Speciality | Dentist |
| Location | 601 W 2nd St, Watonga, Oklahoma |
| Authorized Official Name and Position | Andrea Matli Scoville (OWNER) |
| Authorized Official Contact | 5806237121 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea Matli Scoville Dds Pc 601 W 2nd St Watonga OK 73772-2601 Ph: (580) 623-7121 | Andrea Matli Scoville Dds Pc 601 W 2nd St Watonga OK 73772-2601 Ph: (580) 623-7121 |
| NPI Number | 1881991032 |
|---|---|
| Provider Enumeration Date | 02/24/2011 |
| Last Update Date | 08/29/2016 |
| Medicare PECOS PAC ID | 7517253685 |
|---|---|
| Medicare Enrollment ID | O20160916000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881991032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 4530 (Oklahoma) | Primary |
| Provider Name | Andrea M Scoville |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1215150693 PECOS PAC ID: 2062708142 Enrollment ID: I20160916000214 |
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