Provider Demographics
NPI:1790946374
Name:POWELL BECKER & SCOTT DDS PC
Entity Type:Organization
Organization Name:POWELL BECKER & SCOTT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-881-4300
Mailing Address - Street 1:1200 E WOODHURST
Mailing Address - Street 2:SUITE M100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4260
Mailing Address - Country:US
Mailing Address - Phone:417-881-4300
Mailing Address - Fax:417-881-0776
Practice Address - Street 1:1200 E WOODHURST
Practice Address - Street 2:SUITE M100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4260
Practice Address - Country:US
Practice Address - Phone:417-881-4300
Practice Address - Fax:417-881-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty