Provider Demographics
NPI:1518305325
Name:NII, SCOTT T (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:NII
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 1:125 E BARSTOW AVE
Mailing Address - Street 2:121
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5020
Mailing Address - Country:US
Mailing Address - Phone:559-224-5625
Mailing Address - Fax:
Practice Address - Street 1:125 E BARSTOW AVE
Practice Address - Street 2:121
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5020
Practice Address - Country:US
Practice Address - Phone:559-224-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43053122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice