Provider Demographics
NPI:1558558387
Name:UPCHURCH, SCOTT STEVEN (DDS)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:STEVEN
Last Name:UPCHURCH
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:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-1086
Mailing Address - Country:US
Mailing Address - Phone:903-587-0506
Mailing Address - Fax:
Practice Address - Street 1:113 N CONNETT ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-2626
Practice Address - Country:US
Practice Address - Phone:903-587-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1770122300000X
TX240881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist