Provider Demographics
NPI:1083813117
Name:PATRICIA A SCOTT DDS PA
Entity Type:Organization
Organization Name:PATRICIA A SCOTT DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:941-625-8500
Mailing Address - Street 1:3443 TAMIAMI TRL STE A
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8159
Mailing Address - Country:US
Mailing Address - Phone:941-625-8500
Mailing Address - Fax:941-625-0874
Practice Address - Street 1:3443 TAMIAMI TRL STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8159
Practice Address - Country:US
Practice Address - Phone:941-625-8500
Practice Address - Fax:941-625-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU32617Medicare UPIN