Provider Demographics
NPI:1003250523
Name:SCOTT A WEISKOPF DDS INC
Entity Type:Organization
Organization Name:SCOTT A WEISKOPF DDS INC
Other - Org Name:CORDOVA ORAL AND FACIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-640-3178
Mailing Address - Street 1:8511 MYSEN CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7391
Mailing Address - Country:US
Mailing Address - Phone:314-640-3178
Mailing Address - Fax:
Practice Address - Street 1:8511 MYSEN CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7391
Practice Address - Country:US
Practice Address - Phone:314-640-3178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9560261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery