Healthcare Provider Details

I. General information

NPI: 1043306806
Provider Name (Legal Business Name): STEPHEN DANIEL SCOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4771 MAIN ST
MILLBROOK AL
36054-2859
US

IV. Provider business mailing address

4771 MAIN ST
MILLBROOK AL
36054-2859
US

V. Phone/Fax

Practice location:
  • Phone: 334-290-0595
  • Fax: 334-290-0597
Mailing address:
  • Phone: 334-290-0595
  • Fax: 334-290-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5491
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: