Healthcare Provider Details

I. General information

NPI: 1750295739
Provider Name (Legal Business Name): SCOTT MCLAREN DDS WAXHAW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 CUTHBERTSON RD
WAXHAW NC
28173-6416
US

IV. Provider business mailing address

5504 FULTON RIDGE DR
INDIAN TRAIL NC
28079-4244
US

V. Phone/Fax

Practice location:
  • Phone: 704-587-7336
  • Fax:
Mailing address:
  • Phone: 973-610-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAROL MANCHOLA
Title or Position: REGIONAL MANAGER
Credential:
Phone: 980-875-9158