Healthcare Provider Details

I. General information

NPI: 1962816173
Provider Name (Legal Business Name): SCOTT XAVIER DEAR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N MONROE ST
VERSAILLES MO
65084-1288
US

IV. Provider business mailing address

130 N MONROE ST
VERSAILLES MO
65084-1288
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-5488
  • Fax: 573-378-5488
Mailing address:
  • Phone: 573-378-5488
  • Fax: 573-378-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2014018079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: