Healthcare Provider Details

I. General information

NPI: 1730768557
Provider Name (Legal Business Name): BRIAN SCOTT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 N 1075 W # 100
FARMINGTON UT
84025-2980
US

IV. Provider business mailing address

1838 N 1075 W # 100
FARMINGTON UT
84025-2980
US

V. Phone/Fax

Practice location:
  • Phone: 801-923-1011
  • Fax: 801-923-1022
Mailing address:
  • Phone: 801-923-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SHANNON BIRD
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-923-1011