MEDICARE: SCOTT LAW 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	7037	AZ

General Provider Information

NPI Number	:	1609998855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT LAW DDS

Provider Business Mailing Address
First Line	:	2223 N ALMOND
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-2233
Country	:	US
Telephone Number	:	480-231-7020
Fax Number	:	480-704-2272

Provider Business Practice Location Address
First Line	:	16421 N TATUM BLVD
Second Line	:	SUITE 202
City	:	PHOENIX
State	:	AZ
Zip	:	85032-3454
Country	:	US
Telephone Number	:	602-992-1639
Fax Number	:

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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