Scott Kevin Brecheisen, D.D.S.
Individual provider Active NPI General Practice Dentistry · Grove, OK
NPI 1497779326 · NPPES record last updated Nov 16, 2022
Key facts
- NPI
- 1497779326
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4558 (OK)
- Practice address
- 57 Heffelman Dr
Grove, OK 74344-4549 - Phone
- (918) 786-5533
- Fax
- (918) 336-5584
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4558 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brecheisen, Lumpkin, D.D.S., Inc. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4558 | OK | Yes |
Addresses
Primary practice location
57 Heffelman Dr
Grove, OK 74344-4549
Mailing address
57 Heffelman Dr
Grove, OK 74344-4549
Phone (918) 786-5533
Other providers in Grove, OK
- Jennifer Elizabeth Bowerman
- Karla Dalynne Bowers
- Erica Brady
- Mary E. Brandt
- Felicia Jo Brecheisen
- Carole C Brewer
- Lundi Brook Brickey
- April Brock
- Shelbi Ann Brock
- Hannah Brown
All providers in Grove, OK · General Practice Dentistry in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.