Healthcare Provider Details

I. General information

NPI: 1114978863
Provider Name (Legal Business Name): SCOTT A TRACY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E 300 N
AMERICAN FORK UT
84003-1790
US

IV. Provider business mailing address

976 E 1370 N
AMERICAN FORK UT
84003-8857
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-0933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1458549922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: