Provider Demographics
NPI:1164583019
Name:SCOTT, MALCOLM RAY (DDS)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:RAY
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 1:7517 CAMERON RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-2057
Mailing Address - Country:US
Mailing Address - Phone:512-371-1222
Mailing Address - Fax:512-371-3914
Practice Address - Street 1:7517 CAMERON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-2057
Practice Address - Country:US
Practice Address - Phone:512-371-1222
Practice Address - Fax:512-371-3914
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist