Provider Demographics
NPI:1477210219
Name:CARADONNA, SCOTT D (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:CARADONNA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WILDEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1342
Mailing Address - Country:US
Mailing Address - Phone:617-997-7528
Mailing Address - Fax:
Practice Address - Street 1:20 WILDEWOOD DR
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-1342
Practice Address - Country:US
Practice Address - Phone:617-997-7528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist