Provider Demographics
NPI:1093971376
Name:SCOTT, KEVIN GRAHAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GRAHAM
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 1:422 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047
Mailing Address - Country:US
Mailing Address - Phone:406-222-6061
Mailing Address - Fax:406-222-6062
Practice Address - Street 1:422 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-222-6061
Practice Address - Fax:406-222-6062
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice