Provider Demographics
NPI:1164580734
Name:BARES, SCOTT CHRISTIAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:CHRISTIAN
Last Name:BARES
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 1:401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNA
Mailing Address - State:IL
Mailing Address - Zip Code:61074
Mailing Address - Country:US
Mailing Address - Phone:815-273-2212
Mailing Address - Fax:815-273-1081
Practice Address - Street 1:401 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAVANNA
Practice Address - State:IL
Practice Address - Zip Code:61074
Practice Address - Country:US
Practice Address - Phone:815-273-2212
Practice Address - Fax:815-273-1081
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9200122300000X
IL0190270241223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist