Provider Demographics
NPI:1740239037
Name:SCOTT, PATRICK VINCENT (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:VINCENT
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 OLD LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9547
Mailing Address - Country:US
Mailing Address - Phone:716-927-7175
Mailing Address - Fax:
Practice Address - Street 1:4010 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2155
Practice Address - Country:US
Practice Address - Phone:716-646-9600
Practice Address - Fax:716-646-9603
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211984204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02021621Medicaid
NYCC1469Medicare ID - Type UnspecifiedMEDICARE NUMBER
NY02021621Medicaid