Healthcare Provider Details

I. General information

NPI: 1922235142
Provider Name (Legal Business Name): SCOTT MATTHEW TOMLINSON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6643 HIGHWAY 98
HATTIESBURG MS
39402
US

IV. Provider business mailing address

23 BELLEGRASS BLVD
HATTIESBURG MS
39402-1905
US

V. Phone/Fax

Practice location:
  • Phone: 601-450-6060
  • Fax:
Mailing address:
  • Phone: 601-720-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3498-09
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3498-09
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: