Healthcare Provider Details

I. General information

NPI: 1891915559
Provider Name (Legal Business Name): HADEN CREWS SCOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SOUTH IRISH ST
GREENVILLE TN
37743-4918
US

IV. Provider business mailing address

208 SOUTH IRISH ST
GREENVILLE TN
37743-4918
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-5621
  • Fax:
Mailing address:
  • Phone: 423-639-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS0000003353
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: