Healthcare Provider Details

I. General information

NPI: 1952355208
Provider Name (Legal Business Name): SCOTT A LACLAIR D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 GRAVES STREET
CLAYTON NY
13624
US

IV. Provider business mailing address

775 GRAVES STREET PO BOX 405
CLAYTON NY
13624
US

V. Phone/Fax

Practice location:
  • Phone: 315-686-5142
  • Fax: 315-686-2310
Mailing address:
  • Phone: 315-686-5142
  • Fax: 315-686-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number046003
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number046003
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number046003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: