Provider Demographics
NPI:1821152653
Name:SCOTT, BRYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 STAR TULIP CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7766
Mailing Address - Country:US
Mailing Address - Phone:707-446-3005
Mailing Address - Fax:
Practice Address - Street 1:2611 NUT TREE RD
Practice Address - Street 2:SUITE F
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6939
Practice Address - Country:US
Practice Address - Phone:707-451-2292
Practice Address - Fax:707-451-1106
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA516881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics