Provider Demographics
NPI:1710108246
Name:SILLIMAN, SCOTT BURNETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BURNETT
Last Name:SILLIMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 HIGHWAY 5
Mailing Address - Street 2:SUITE C
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1501
Mailing Address - Country:US
Mailing Address - Phone:770-920-8067
Mailing Address - Fax:
Practice Address - Street 1:9280 HIGHWAY 5
Practice Address - Street 2:SUITE C
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1501
Practice Address - Country:US
Practice Address - Phone:770-920-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice