Healthcare Provider Details

I. General information

NPI: 1326690264
Provider Name (Legal Business Name): SCOTT ELSEY DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MAIN ST
PICKFORD MI
49774-8936
US

IV. Provider business mailing address

PO BOX 308
PICKFORD MI
49774-0308
US

V. Phone/Fax

Practice location:
  • Phone: 906-647-9201
  • Fax:
Mailing address:
  • Phone: 586-339-5083
  • 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 PATRICK ELSEY
Title or Position: SOLE OWNER
Credential: DDS
Phone: 586-339-5083