Provider Demographics
NPI:1003908096
Name:CHURCHILL, SCOTT PERRINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PERRINE
Last Name:CHURCHILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-1706
Mailing Address - Country:US
Mailing Address - Phone:916-638-4641
Mailing Address - Fax:916-638-4795
Practice Address - Street 1:2001 ZINFANDEL DR
Practice Address - Street 2:SUITE A2
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4265
Practice Address - Country:US
Practice Address - Phone:916-638-4641
Practice Address - Fax:916-638-4795
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice