Provider Demographics
NPI:1093900946
Name:SCOTT, JUSTIN STUART (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:STUART
Last Name:SCOTT
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 1:4680 MONTICELLO AVE
Mailing Address - Street 2:#16A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8214
Mailing Address - Country:US
Mailing Address - Phone:757-258-1042
Mailing Address - Fax:
Practice Address - Street 1:4680 MONTICELLO AVE
Practice Address - Street 2:#16A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8214
Practice Address - Country:US
Practice Address - Phone:757-258-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist