Provider Demographics
NPI:1578791109
Name:SCOTT, MARK BRENT II (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRENT
Last Name:SCOTT
Suffix:II
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 1:2503 BUSH RIDGE DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245
Mailing Address - Country:US
Mailing Address - Phone:502-240-0649
Mailing Address - Fax:502-240-0649
Practice Address - Street 1:2503 BUSH RIDGE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245
Practice Address - Country:US
Practice Address - Phone:502-240-0649
Practice Address - Fax:502-240-0649
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8798122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist