Healthcare Provider Details

I. General information

NPI: 1740239037
Provider Name (Legal Business Name): PATRICK VINCENT SCOTT D.D.S. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-2155
US

IV. Provider business mailing address

6108 OLD LAKE SHORE RD
LAKEVIEW NY
14085-9547
US

V. Phone/Fax

Practice location:
  • Phone: 716-646-9600
  • Fax: 716-646-9603
Mailing address:
  • Phone: 716-927-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number211984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: