Provider Demographics
NPI:1821123647
Name:SCOTT, STEPHEN A (DDS,MS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4520
Mailing Address - Country:US
Mailing Address - Phone:870-862-8850
Mailing Address - Fax:870-862-2777
Practice Address - Street 1:705 W FAULKNER ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4520
Practice Address - Country:US
Practice Address - Phone:870-862-8850
Practice Address - Fax:870-862-2777
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics