Provider Demographics
NPI:1710155825
Name:SCOTT W. CLINTON, D.D.S.,P.C.
Entity Type:Organization
Organization Name:SCOTT W. CLINTON, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-376-8824
Mailing Address - Street 1:1011 E. TOUHY AVENUE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018
Mailing Address - Country:US
Mailing Address - Phone:847-376-8824
Mailing Address - Fax:
Practice Address - Street 1:1011 E. TOUHY AVE
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1958
Practice Address - Country:US
Practice Address - Phone:847-376-8824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty