Provider Demographics
NPI:1619222726
Name:SCOTT, VINCENT PETER
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PETER
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7985
Mailing Address - Country:US
Mailing Address - Phone:310-823-5377
Mailing Address - Fax:
Practice Address - Street 1:8035 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7985
Practice Address - Country:US
Practice Address - Phone:310-823-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice