Provider Demographics
NPI:1467773390
Name:SCOTT, EDWARD RAY II (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RAY
Last Name:SCOTT
Suffix:II
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 1:75 EASTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-0917
Mailing Address - Country:US
Mailing Address - Phone:304-767-8198
Mailing Address - Fax:
Practice Address - Street 1:508 10TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2339
Practice Address - Country:US
Practice Address - Phone:828-695-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice