Provider Demographics
NPI:1629289145
Name:BLYER, SCOTT MARSHALL (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MARSHALL
Last Name:BLYER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 EXPRESSWAY DR S
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5575
Mailing Address - Country:US
Mailing Address - Phone:631-232-2636
Mailing Address - Fax:888-807-6323
Practice Address - Street 1:3750 EXPRESSWAY DR S
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5575
Practice Address - Country:US
Practice Address - Phone:631-232-2636
Practice Address - Fax:888-807-6323
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244114-1174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist