Provider Demographics
NPI:1346309259
Name:SCOTT, KEVIN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3275 APTOS RANCHO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3983
Mailing Address - Country:US
Mailing Address - Phone:831-688-1997
Mailing Address - Fax:831-688-0522
Practice Address - Street 1:3275 APTOS RANCHO RD
Practice Address - Street 2:SUITE C
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3983
Practice Address - Country:US
Practice Address - Phone:831-688-1997
Practice Address - Fax:831-688-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice