Healthcare Provider Details

I. General information

NPI: 1528243771
Provider Name (Legal Business Name): SCOTT FAMILY DENTISTRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BROADWAY AVE SUITE 105
YANKTON SD
57078-2835
US

IV. Provider business mailing address

1101 BROADWAY AVE SUITE 105
YANKTON SD
57078-2835
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-2448
  • Fax: 605-665-1404
Mailing address:
  • Phone: 605-665-2448
  • Fax: 605-665-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD0639
License Number StateSD

VIII. Authorized Official

Name: DR. JESSIE BETH SCOTT
Title or Position: OWNER
Credential: DDS
Phone: 605-665-2448