Provider Demographics
NPI:1578092292
Name:SCOTT, KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:SCOTT
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 1:302 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:IN
Mailing Address - Zip Code:47512-1812
Mailing Address - Country:US
Mailing Address - Phone:812-735-2754
Mailing Address - Fax:
Practice Address - Street 1:302 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:IN
Practice Address - Zip Code:47512-1812
Practice Address - Country:US
Practice Address - Phone:812-735-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012697A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice