Provider Demographics
NPI:1861920886
Name:SCHRECK, CONSTANCE (DMD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:SCHRECK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SAWGRASS RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8370
Mailing Address - Country:US
Mailing Address - Phone:405-408-2307
Mailing Address - Fax:
Practice Address - Street 1:1300 CROP CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-4945
Practice Address - Country:US
Practice Address - Phone:405-267-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice