MEDICARE: DR. BROOKE NICHOLE 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	12013140A	IN

General Provider Information

NPI Number	:	1932766508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKE NICHOLE SCOTT DDS

Provider Business Mailing Address
First Line	:	1661 W MAIN ST
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-8825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 E 71ST ST STE 3
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-3900
Country	:	US
Telephone Number	:	317-479-2340
Fax Number	:

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

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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