Provider Demographics
NPI:1689960452
Name:BOSSERT, SCOTT PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PAUL
Last Name:BOSSERT
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 1:7777 US HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9102
Mailing Address - Country:US
Mailing Address - Phone:740-289-3508
Mailing Address - Fax:740-289-8951
Practice Address - Street 1:7777 US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9102
Practice Address - Country:US
Practice Address - Phone:740-289-3508
Practice Address - Fax:740-289-8951
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300234301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice