Healthcare Provider Details

I. General information

NPI: 1619997681
Provider Name (Legal Business Name): SCOTT D ARNOLD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W BRANDON BLVD
BRANDON FL
33511-5103
US

IV. Provider business mailing address

257 W BRANDON BLVD
BRANDON FL
33511-5103
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-1529
  • Fax: 813-684-8595
Mailing address:
  • Phone: 813-689-1529
  • Fax: 813-684-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN14255
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN14255
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN14255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: