Healthcare Provider Details

I. General information

NPI: 1093900946
Provider Name (Legal Business Name): JUSTIN STUART SCOTT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GASKINS RD
HENRICO VA
23238-1402
US

IV. Provider business mailing address

2600 GASKINS RD
HENRICO VA
23238-1402
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-8200
  • Fax: 804-288-4886
Mailing address:
  • Phone: 804-288-8200
  • Fax: 804-288-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401411928
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: