MEDICARE: DR. VIRGINIA G SCOTT 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	4505	WI

General Provider Information

NPI Number	:	1649390063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA G SCOTT DDS

Provider Business Mailing Address
First Line	:	403 W. CHESTNUT ST.
Second Line	:	PO BOX 127
City	:	PARDEEVILLE
State	:	WI
Zip	:	53954-0127
Country	:	US
Telephone Number	:	608-429-3175
Fax Number	:	608-429-3776

Provider Business Practice Location Address
First Line	:	403 W. CHESTNUT ST.
Second Line	:
City	:	PARDEEVILLE
State	:	WI
Zip	:	53954
Country	:	US
Telephone Number	:	608-429-3175
Fax Number	:	608-429-3776

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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