Healthcare Provider Details

I. General information

NPI: 1760712160
Provider Name (Legal Business Name): SCOTT BRADLY ESSIG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S I H 35 STE 1-D
AUSTIN TX
78744-4824
US

IV. Provider business mailing address

2513 COUNTRYSIDE CIR
SPICEWOOD TX
78669-3046
US

V. Phone/Fax

Practice location:
  • Phone: 512-608-4420
  • Fax:
Mailing address:
  • Phone: 212-920-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: