Provider Demographics
NPI:1477558567
Name:STAFFEL, SCOTT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:STAFFEL
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 1:3001 BROWN TRL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3204
Mailing Address - Country:US
Mailing Address - Phone:817-503-9300
Mailing Address - Fax:
Practice Address - Street 1:3001 BROWN TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3204
Practice Address - Country:US
Practice Address - Phone:817-503-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD18197OtherBLUE CROSS ID
TXD18197OtherBLUE CROSS ID