Provider Demographics
NPI:1083690820
Name:PROCTOR, DAN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:SCOTT
Last Name:PROCTOR
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 1:8497 GRATIOT RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-4807
Mailing Address - Country:US
Mailing Address - Phone:989-781-2230
Mailing Address - Fax:989-781-2231
Practice Address - Street 1:8497 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-4807
Practice Address - Country:US
Practice Address - Phone:989-781-2230
Practice Address - Fax:989-781-2231
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice