Provider Demographics
NPI:1407976830
Name:VIRGINIA G SCOTT DDS
Entity Type:Organization
Organization Name:VIRGINIA G SCOTT DDS
Other - Org Name:PARDEEVILLE FAMILY DENTISTRY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-429-3175
Mailing Address - Street 1:403 W. CHESTNUT ST.
Mailing Address - Street 2:P.O. BOX 127
Mailing Address - City:PARDEEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53954-0127
Mailing Address - Country:US
Mailing Address - Phone:608-429-3175
Mailing Address - Fax:608-429-3776
Practice Address - Street 1:403 W. CHESTNUT ST.
Practice Address - Street 2:
Practice Address - City:PARDEEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53954
Practice Address - Country:US
Practice Address - Phone:608-429-3175
Practice Address - Fax:608-429-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty