Provider Demographics
NPI:1215044466
Name:SCOTT, RICHARD CAMPBELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CAMPBELL
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 1:190 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1447
Mailing Address - Country:US
Mailing Address - Phone:734-979-0979
Mailing Address - Fax:734-927-1169
Practice Address - Street 1:190 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1447
Practice Address - Country:US
Practice Address - Phone:734-979-0979
Practice Address - Fax:734-927-1169
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010163871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice