Provider Demographics
NPI:1689669236
Name:SCOTT, WAYNE D (DDS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LAMAR AVE
Mailing Address - Street 2:STE M
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4460
Mailing Address - Country:US
Mailing Address - Phone:903-785-7528
Mailing Address - Fax:903-785-1870
Practice Address - Street 1:707 LAMAR AVE
Practice Address - Street 2:STE M
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4460
Practice Address - Country:US
Practice Address - Phone:903-785-7528
Practice Address - Fax:903-785-1870
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX177711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD17771Medicare ID - Type Unspecified
TXU06444Medicare UPIN