Healthcare Provider Details

I. General information

NPI: 1679142673
Provider Name (Legal Business Name): ALEX W SCOTT DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 EDEN PRAIRIE ROAD SUITE A
MINNETONKA MN
55345
US

IV. Provider business mailing address

5509 EDEN PRAIRIE ROAD SUITE A
MINNETONKA MN
55345
US

V. Phone/Fax

Practice location:
  • Phone: 952-938-6038
  • Fax: 952-935-9175
Mailing address:
  • Phone: 952-938-6038
  • Fax: 952-935-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEX SCOTT
Title or Position: OWNER
Credential:
Phone: 952-938-6038