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General NPI Number Information
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NPI Number | 1861906711
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Entity Type | Organization
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Legal Business Name | TODD S SCOTT DDS PC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 2716 FORUM BLVD STE 1
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City | COLUMBIA
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State | MO
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Zip | 65203-5450
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Country | US
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Telephone | 573-446-3709
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Fax | 573-446-0861
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Provider Business Mailing Address
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Address Line | 2716 FORUM BLVD STE 1
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City | COLUMBIA
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State | MO
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Zip | 65203-5450
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Country | US
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Telephone | 573-446-3709
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Fax | 573-446-0861
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD DONALD SCOTT
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Credential | DDS
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Telephone | 573-446-3709
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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 | 015928
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License Number State | MO
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