Provider Demographics
NPI:1760545461
Name:STOTT, ELDON DEAN (DDS)
Entity Type:Individual
Prefix:
First Name:ELDON
Middle Name:DEAN
Last Name:STOTT
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 1:857 E WARNER RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3074
Mailing Address - Country:US
Mailing Address - Phone:480-821-4868
Mailing Address - Fax:480-821-4724
Practice Address - Street 1:857 E WARNER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3074
Practice Address - Country:US
Practice Address - Phone:480-821-4868
Practice Address - Fax:480-821-4724
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice