Provider Demographics
NPI:1639225394
Name:SCOTT, MONA LISA (RDA)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:LISA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-6246
Mailing Address - Country:US
Mailing Address - Phone:423-337-8246
Mailing Address - Fax:
Practice Address - Street 1:600 RAYDER AVE
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1050
Practice Address - Country:US
Practice Address - Phone:465-458-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10611126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10611OtherREGISTERED DENTAL ASSISTA