Provider Demographics
NPI:1477034130
Name:CARR, SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:CARR
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 1:2100 GOODYEAR AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7749
Mailing Address - Country:US
Mailing Address - Phone:805-985-1159
Mailing Address - Fax:
Practice Address - Street 1:2100 GOODYEAR AVE
Practice Address - Street 2:STE 11
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7749
Practice Address - Country:US
Practice Address - Phone:805-409-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist