Provider Demographics
NPI:1518050368
Name:SITLER, SCOTT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:SITLER
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 1:921 E TINKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1537
Mailing Address - Country:US
Mailing Address - Phone:231-845-6313
Mailing Address - Fax:231-843-8828
Practice Address - Street 1:921 E TINKHAM AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1537
Practice Address - Country:US
Practice Address - Phone:231-845-6313
Practice Address - Fax:231-843-8828
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010123091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4050904Medicaid