Provider Demographics
NPI:1821110552
Name:SCOTT, ROGER W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:A
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:212 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4030
Mailing Address - Country:US
Mailing Address - Phone:386-255-3626
Mailing Address - Fax:386-253-9529
Practice Address - Street 1:212 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4030
Practice Address - Country:US
Practice Address - Phone:386-255-3626
Practice Address - Fax:386-253-9529
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00118751223G0001X
FLDN00111621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice