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General NPI Number Information
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NPI Number | 1700021292
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Entity Type | Organization
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Legal Business Name | SCOTT FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 716 W. SOUTH STREET
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-778-8201
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Fax |
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Provider Business Mailing Address
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Address Line | 716 W. SOUTH STREET
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-778-8201
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. TIMOTHY BRIAN SCOTT
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Credential | DDS
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Telephone | 501-778-8201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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