MEDICARE: DELUXE DENTAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	22DI02574700	NJ

General Provider Information

NPI Number	:	1598274896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELUXE DENTAL GROUP LLC

Provider Business Mailing Address
First Line	:	6 THORESEN RD
Second Line	:
City	:	WARREN
State	:	NJ
Zip	:	07059-7022
Country	:	US
Telephone Number	:	732-948-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 WASHINGTON VALLEY RD STE 202
Second Line	:
City	:	WARREN
State	:	NJ
Zip	:	07059-7177
Country	:	US
Telephone Number	:	732-948-4122
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST, OWNER
Name	:	DR. WILLIAM FRANCIS SCOTT IV
Credential	:	DMD
Telephone Number	:	732-948-4122

Provider Enumeration Date	:	09/29/2017
Last Update Date	:	09/29/2017

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