Provider Demographics
NPI:1740398007
Name:SCOTT, STEPHEN JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAY
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 1:40 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2600
Mailing Address - Country:US
Mailing Address - Phone:203-629-4598
Mailing Address - Fax:
Practice Address - Street 1:40 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2600
Practice Address - Country:US
Practice Address - Phone:203-629-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice