Provider Demographics
NPI:1578553111
Name:BINGHAM, SCOTT NMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:NMI
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:DMD
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 8246
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87198-8246
Mailing Address - Country:US
Mailing Address - Phone:505-256-7711
Mailing Address - Fax:505-256-8099
Practice Address - Street 1:7711 ZUNI RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3216
Practice Address - Country:US
Practice Address - Phone:505-256-7711
Practice Address - Fax:505-256-8099
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD20351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice