Provider Demographics
NPI:1487036331
Name:ADCOCK, SCOTT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:ADCOCK
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 1:2904 N 4TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5129
Mailing Address - Country:US
Mailing Address - Phone:903-758-3700
Mailing Address - Fax:903-234-8658
Practice Address - Street 1:2904 N 4TH ST
Practice Address - Street 2:STE 106
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5129
Practice Address - Country:US
Practice Address - Phone:903-758-3700
Practice Address - Fax:903-234-8658
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice