MEDICARE: SCOTT ELIOT ENGLE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401414435	VA

General Provider Information

NPI Number	:	1295147031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ELIOT ENGLE DDS

Provider Business Mailing Address
First Line	:	1357 N GREAT NECK RD STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2237
Country	:	US
Telephone Number	:	757-481-5900
Fax Number	:	757-222-1010

Provider Business Practice Location Address
First Line	:	2404 POTTERS RD
Second Line	:	SUITE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4335
Country	:	US
Telephone Number	:	757-340-8805
Fax Number	:	757-340-8803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2014
Last Update Date	:	09/01/2021

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