MEDICARE: SCOTT BRADLY ESSIG 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	25020	TX

General Provider Information

NPI Number	:	1760712160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT BRADLY ESSIG DDS

Provider Business Mailing Address
First Line	:	2513 COUNTRYSIDE CIR
Second Line	:
City	:	SPICEWOOD
State	:	TX
Zip	:	78669-3046
Country	:	US
Telephone Number	:	212-920-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 S I H 35 STE 1-D
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-4824
Country	:	US
Telephone Number	:	512-608-4420
Fax Number	:

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

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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