Healthcare Provider Details

I. General information

NPI: 1659940575
Provider Name (Legal Business Name): BECKER AND SCOTT DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 S FREMONT AVE
SPRINGFIELD MO
65804-6503
US

IV. Provider business mailing address

3836 S FREMONT AVE
SPRINGFIELD MO
65804-6503
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-4300
  • Fax: 417-881-0776
Mailing address:
  • Phone: 417-881-4300
  • Fax: 417-881-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG STEPHEN SCOTT
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 417-881-4300