Provider Demographics
NPI:1063632214
Name:SCOTT, GREGORY P (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
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 1:5110 S LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2500
Mailing Address - Country:US
Mailing Address - Phone:863-709-1941
Mailing Address - Fax:863-709-8091
Practice Address - Street 1:5110 S LAKELAND DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2500
Practice Address - Country:US
Practice Address - Phone:863-709-1941
Practice Address - Fax:863-709-8091
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN112021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN11202OtherLICIENSE
FLDN11202OtherLICIENSE