Provider Demographics
NPI:1518196039
Name:PASIETA, SCOTT ANTHONY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ANTHONY
Last Name:PASIETA
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 1:2104 MASSEY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32228
Mailing Address - Country:US
Mailing Address - Phone:904-270-4484
Mailing Address - Fax:
Practice Address - Street 1:2104 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32228-5285
Practice Address - Country:US
Practice Address - Phone:904-270-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145411223P0300X
HIDT-25891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics