MEDICARE: DR. SCOTT ENLOW

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	122300000X	Dentist	38930	TX

General Provider Information

NPI Number	:	1306565650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT ENLOW

Provider Business Mailing Address
First Line	:	3836 ANTIGUA DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-6603
Country	:	US
Telephone Number	:	972-400-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	7965 CUSTER RD STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-3155
Country	:	US
Telephone Number	:	972-517-6453
Fax Number	:

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

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	06/03/2024

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Directions to “ DR. SCOTT ENLOW ” Practice Location

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