=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598166290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANLEY J. SCOTT, DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2014
-----------------------------------------------------
Last Update Date | 09/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5020 LAKE SHORE RD
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14075-5719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-627-7200
-----------------------------------------------------
Fax | 716-627-7279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5020 LAKE SHORE RD
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14075-5719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-627-7200
-----------------------------------------------------
Fax | 716-627-7279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | ELLEN KUEHLEWIND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-627-7200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 031610
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------