Provider Demographics
NPI:1114001898
Name:SCHEURICH, SCOTT G (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:SCHEURICH
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 SUMMIT BLVD
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-8318
Mailing Address - Country:US
Mailing Address - Phone:850-474-0404
Mailing Address - Fax:850-474-0402
Practice Address - Street 1:3298 SUMMIT BLVD
Practice Address - Street 2:SUITE # 6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-8318
Practice Address - Country:US
Practice Address - Phone:850-474-0404
Practice Address - Fax:850-474-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 136121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FMDN 13612OtherDENTAL LISCENSE #