Provider Demographics
NPI:1114946167
Name:SCOTT, RANDAL ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:ALAN
Last Name:SCOTT
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 1:701 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-4030
Mailing Address - Country:US
Mailing Address - Phone:573-636-7432
Mailing Address - Fax:573-636-0438
Practice Address - Street 1:701 E HIGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-4030
Practice Address - Country:US
Practice Address - Phone:573-636-7432
Practice Address - Fax:573-636-0438
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice