=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124292131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JON L SCOTT, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2008
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1186 BIG BETHEL RD
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-825-6280
-----------------------------------------------------
Fax | 757-825-4995
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1186 BIG BETHEL RD
-----------------------------------------------------
City | HAMPTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23666-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JON SCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-825-6280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 5160
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------