MEDICARE: SCOTT MCNAIRY DDS PLLC

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	00203057	CO

General Provider Information

NPI Number	:	1578049839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT MCNAIRY DDS PLLC

Provider Business Mailing Address
First Line	:	1136 E STUART ST STE 3140
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1196
Country	:	US
Telephone Number	:	970-482-1520
Fax Number	:	970-482-1752

Provider Business Practice Location Address
First Line	:	1136 E STUART ST STE 3140
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1196
Country	:	US
Telephone Number	:	970-482-1520
Fax Number	:	970-482-1752

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT DENNIS MCNAIRY
Credential	:	DDS
Telephone Number	:	970-689-9759

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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