Provider Demographics
NPI:1811007610
Name:COLEV, SCOTT NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:NEIL
Last Name:COLEV
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 1:1645 E BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85106
Mailing Address - Country:US
Mailing Address - Phone:602-265-7727
Mailing Address - Fax:602-266-0607
Practice Address - Street 1:1645 E BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85106
Practice Address - Country:US
Practice Address - Phone:602-265-7727
Practice Address - Fax:602-266-0607
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ25831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice