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General NPI Number Information
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NPI Number | 1639225394
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Entity Type | Individual
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Provider Name | MONA LISA SCOTT RDA
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 600 RAYDER AVE
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City | LOUDON
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State | TN
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Zip | 37774-1050
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Country | US
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Telephone | 465-458-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 140 EASTWOOD DR
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City | SWEETWATER
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State | TN
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Zip | 37874-6246
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Country | US
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Telephone | 423-337-8246
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 10611
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License Number State | TN
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