Provider Demographics
NPI:1336134048
Name:DUDLEY, SCOTT BRANIN (DMD, MSED, FAGD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BRANIN
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:DMD, MSED, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N FILLMORE STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201
Mailing Address - Country:US
Mailing Address - Phone:703-243-4500
Mailing Address - Fax:703-243-4100
Practice Address - Street 1:1025 N FILLMORE STREET
Practice Address - Street 2:SUITE C
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201
Practice Address - Country:US
Practice Address - Phone:703-243-4500
Practice Address - Fax:703-243-4100
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000421122300000X
NJ22D102229700122300000X
NC7973122300000X
VA0401412031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist