Provider Demographics
NPI:1396034773
Name:SCOTT, BRIAN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:G
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 1:1641 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2062
Mailing Address - Country:US
Mailing Address - Phone:719-545-2722
Mailing Address - Fax:719-545-7427
Practice Address - Street 1:1641 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2062
Practice Address - Country:US
Practice Address - Phone:719-545-2722
Practice Address - Fax:719-545-7427
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98681223X0400X
CODEN00098681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics