Provider Demographics
NPI:1649583790
Name:SCOTTI, KEVIN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:SCOTTI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SAINT FRANCIS ST.
Mailing Address - Street 2:APT. 804
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-481-1526
Mailing Address - Fax:
Practice Address - Street 1:901 N STUART ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1821
Practice Address - Country:US
Practice Address - Phone:703-822-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist