Provider Demographics
NPI:1497704571
Name:RANKIN, SCOTT JOHN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOHN
Last Name:RANKIN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA DENTAL HEALTH ACTIVITY
Mailing Address - Street 2:BLDG 38801 ACADEMIC DR, SUITE B&C
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5660
Mailing Address - Country:US
Mailing Address - Phone:706-787-5738
Mailing Address - Fax:706-787-2082
Practice Address - Street 1:USA DENTAL HEALTH ACTIVITY
Practice Address - Street 2:BLDG 38801 ACADEMIC DR, SUITE B&C
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-5738
Practice Address - Fax:706-787-2082
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008870122300000X, 1223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health