Provider Demographics
NPI:1871584060
Name:DENNIS, JOHN SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:DENNIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4500 S GARNETT RD
Mailing Address - Street 2:STE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5238
Mailing Address - Country:US
Mailing Address - Phone:918-728-6194
Mailing Address - Fax:855-917-2040
Practice Address - Street 1:4500 S GARNETT RD
Practice Address - Street 2:STE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5229
Practice Address - Country:US
Practice Address - Phone:918-728-6194
Practice Address - Fax:918-664-0267
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK24522085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100062800AMedicaid
OKOSTER102Medicare PIN
OKOSTER102Medicare Oscar/Certification
OK100062800AMedicaid
OK360002375Medicare PIN