MEDICARE: SCOTT ENDODONTICS

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1881146595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT ENDODONTICS

Provider Business Mailing Address
First Line	:	2503 BUSH RIDGE DRIVE
Second Line	:	SUITE C
City	:	LOUISVILLE
State	:	KY
Zip	:	40245
Country	:	US
Telephone Number	:	502-240-0649
Fax Number	:	502-240-0649

Provider Business Practice Location Address
First Line	:	2503 BUSH RIDGE DRIVE
Second Line	:	SUITE C
City	:	LOUISVILLE
State	:	KY
Zip	:	40245
Country	:	US
Telephone Number	:	502-240-0649
Fax Number	:	502-240-0649

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK BRENT SCOTT II
Credential	:	DMD
Telephone Number	:	502-240-0649

Provider Enumeration Date	:	10/28/2016
Last Update Date	:	04/27/2023

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