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General NPI Number Information
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NPI Number | 1093004467
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Entity Type | Organization
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Legal Business Name | SCOTT GORDEN STAFFORD, DDS, PC
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 12501 JUDSON RD SUITE 101
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City | LIVE OAK
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State | TX
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Zip | 78233-4103
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Country | US
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Telephone | 210-599-9610
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Fax | 210-946-8119
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Provider Business Mailing Address
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Address Line | 12501 JUDSON RD SUITE101
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City | LIVE OAK
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State | TX
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Zip | 78233-4103
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Country | US
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Telephone | 210-599-9610
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Fax | 210-946-8119
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT G STAFFORD
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Credential | DDS
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Telephone | 210-599-9610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18592
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License Number State | TX
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