Provider Demographics
NPI:1326690264
Name:SCOTT ELSEY DDS PLLC
Entity Type:Organization
Organization Name:SCOTT ELSEY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:ELSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-339-5083
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:PICKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49774-0308
Mailing Address - Country:US
Mailing Address - Phone:586-339-5083
Mailing Address - Fax:
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PICKFORD
Practice Address - State:MI
Practice Address - Zip Code:49774-8936
Practice Address - Country:US
Practice Address - Phone:906-647-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty