Provider Demographics
NPI:1487035580
Name:ANTONIO, SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:ANTONIO
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 1:151 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2245
Mailing Address - Country:US
Mailing Address - Phone:239-218-9614
Mailing Address - Fax:850-477-5532
Practice Address - Street 1:151 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-2245
Practice Address - Country:US
Practice Address - Phone:850-477-5252
Practice Address - Fax:850-477-5532
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85421223G0001X
FLDN21199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice