Provider Demographics
NPI:1821180886
Name:BEDICHEK, SCOTT (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BEDICHEK
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 1:5310 N. TARRANT PARKWAY #104
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248
Mailing Address - Country:US
Mailing Address - Phone:817-581-4867
Mailing Address - Fax:817-581-4866
Practice Address - Street 1:5310 NORTH TARRANT PARKWAY #104
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-581-4867
Practice Address - Fax:817-581-4866
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231391223P0300X
OK57301223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics