Provider Demographics
NPI:1467470781
Name:LAWSON, SCOTT D (DDS, MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 N GOLDENROD RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3727 N GOLDENROD RD STE 108
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8611
Practice Address - Country:US
Practice Address - Phone:407-671-0001
Practice Address - Fax:407-671-3496
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME907171223S0112X
FLDN169231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000500700Medicaid
FL64254OtherMEDICARE ID NUMBER
11918447OtherCAQH
FL64254OtherMEDICARE ID NUMBER