=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386776466
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | D CRAIG SCOTT DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 WASHINGTON ST
-----------------------------------------------------
City | BICKNELL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-735-2754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 215 302 WASHINGTON ST
-----------------------------------------------------
City | BICKNELL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-735-2754
-----------------------------------------------------
Fax | 812-735-2129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 12008032
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------