Provider Demographics
NPI:1578517736
Name:SMORON, SCOTT GREGORY (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GREGORY
Last Name:SMORON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3031
Mailing Address - Country:US
Mailing Address - Phone:847-255-2526
Mailing Address - Fax:
Practice Address - Street 1:421 W PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3031
Practice Address - Country:US
Practice Address - Phone:847-255-2526
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics