=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962416016
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIMOTHY BRIAN SCOTT DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 716 W SOUTH ST
-----------------------------------------------------
City | BENTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72015-4160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-778-8201
-----------------------------------------------------
Fax | 501-778-2841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 716 W SOUTH ST
-----------------------------------------------------
City | BENTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72015-4160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-778-8201
-----------------------------------------------------
Fax | 501-778-2841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3247
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------