=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740239037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK VINCENT SCOTT D.D.S. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2006
-----------------------------------------------------
Last Update Date | 10/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4010 SOUTHWESTERN BLVD
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-646-9600
-----------------------------------------------------
Fax | 716-646-9603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6108 OLD LAKE SHORE RD
-----------------------------------------------------
City | LAKEVIEW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14085-9547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-927-7175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number | 211984
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------