Organization Name: | SCOTT DENTAL GROUP L L C |
NPI Number: | 1073828786 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARREL L SCOTT (OWNER) |
Mailing Address: | 633 N Union St Loudonville |
State: | OH US |
Postal Code: | 448421074 |
Phone Number: | 4199943111 |
Fax Number: | 4199944078 |
NPI Enumeration Date: | 08/18/2010 |
NPI Last Update Date: | 08/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 16373 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |