MEDICARE: DR. SCOTT B EISEN D.D.S.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	15232	MD

General Provider Information

NPI Number	:	1891050944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT B EISEN D.D.S.

Provider Business Mailing Address
First Line	:	11092 HIDDEN TRAIL DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-2356
Country	:	US
Telephone Number	:	410-218-7744
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 FREDERICK RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-4625
Country	:	US
Telephone Number	:	410-747-1115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2012
Last Update Date	:	06/27/2013

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