Healthcare Provider Details

I. General information

NPI: 1467640904
Provider Name (Legal Business Name): SCOTT NATHANIEL FREDERICK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3236 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4077
US

IV. Provider business mailing address

9296 STONEGLEN DR
COLORADO SPRINGS CO
80920-3026
US

V. Phone/Fax

Practice location:
  • Phone: 719-355-2700
  • Fax:
Mailing address:
  • Phone: 719-646-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10115
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: