Provider Demographics
NPI:1760712160
Name:ESSIG, SCOTT BRADLY (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:BRADLY
Last Name:ESSIG
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 1:2513 COUNTRYSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-3046
Mailing Address - Country:US
Mailing Address - Phone:212-920-9509
Mailing Address - Fax:
Practice Address - Street 1:6801 S I H 35 STE 1-D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4824
Practice Address - Country:US
Practice Address - Phone:512-608-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice