Healthcare Provider Details

I. General information

NPI: 1710155825
Provider Name (Legal Business Name): SCOTT W. CLINTON, D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E. TOUHY AVE
DES PLAINES IL
60018-1958
US

IV. Provider business mailing address

1011 E. TOUHY AVENUE
DES PLAINES IL
60018
US

V. Phone/Fax

Practice location:
  • Phone: 847-376-8824
  • Fax:
Mailing address:
  • Phone: 847-376-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT WALTER CLINTON
Title or Position: PRESIDENT
Credential:
Phone: 847-376-8824