Provider Demographics
NPI:1609960400
Name:MCLAURIN, SCOTT O (DMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:O
Last Name:MCLAURIN
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 1:2200 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7369
Mailing Address - Country:US
Mailing Address - Phone:706-596-1895
Mailing Address - Fax:706-596-1030
Practice Address - Street 1:2200 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7369
Practice Address - Country:US
Practice Address - Phone:706-596-1895
Practice Address - Fax:706-596-1030
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA124201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00921599Medicaid