Provider Demographics
NPI:1518980655
Name:KISSINGER, SCOTT ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:KISSINGER
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 1:1389 MEYERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1818
Mailing Address - Country:US
Mailing Address - Phone:303-470-5384
Mailing Address - Fax:
Practice Address - Street 1:7889 S LINCOLN CT
Practice Address - Street 2:SUITE 202
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2651
Practice Address - Country:US
Practice Address - Phone:303-798-4967
Practice Address - Fax:303-798-2403
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice