Provider Demographics
NPI:1043709868
Name:SCOTT, JACOB BRANDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:BRANDON
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3676 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1359
Mailing Address - Country:US
Mailing Address - Phone:614-453-2806
Mailing Address - Fax:
Practice Address - Street 1:3676 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1359
Practice Address - Country:US
Practice Address - Phone:614-453-2806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist