Provider Demographics
NPI:1376876771
Name:AMES, SCOTT GRANVILLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GRANVILLE
Last Name:AMES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 STICKNEY PT. RD.
Mailing Address - Street 2:SUITE 101-B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231
Mailing Address - Country:US
Mailing Address - Phone:941-923-1910
Mailing Address - Fax:
Practice Address - Street 1:2477 STICKNEY POINT RD
Practice Address - Street 2:SUITE 101-B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4076
Practice Address - Country:US
Practice Address - Phone:941-923-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 93971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice