MEDICARE: RICHARD L. SCOTTI D.D.S. P.A.

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	DI15912	NJ

General Provider Information

NPI Number	:	1548479033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD L. SCOTTI D.D.S. P.A.

Provider Business Mailing Address
First Line	:	470 STATE ROUTE 79
Second Line	:
City	:	MORGANVILLE
State	:	NJ
Zip	:	07751-4700
Country	:	US
Telephone Number	:	732-591-5560
Fax Number	:	732-591-2292

Provider Business Practice Location Address
First Line	:	470 STATE ROUTE 79
Second Line	:
City	:	MORGANVILLE
State	:	NJ
Zip	:	07751-4700
Country	:	US
Telephone Number	:	732-591-5560
Fax Number	:	732-591-2292

Authorized Official
Title or Position	:	DENTIST-OWNER
Name	:	DR. RICHARD L. SCOTTI
Credential	:	D.D.S.
Telephone Number	:	732-591-5560

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	01/31/2013

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