Provider Demographics
NPI:1649205477
Name:SCOTT, WALTER STUART III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:STUART
Last Name:SCOTT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:686 STOCKBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0300
Mailing Address - Country:US
Mailing Address - Phone:910-323-3133
Mailing Address - Fax:910-323-9616
Practice Address - Street 1:2935 BREEZEWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5284
Practice Address - Country:US
Practice Address - Phone:910-323-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997606Medicaid