Provider Demographics
NPI:1821264896
Name:FORVILLY, SCOTT MAXMILLIAN (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MAXMILLIAN
Last Name:FORVILLY
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 1:50 E HASKELL ST STE C
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3576
Mailing Address - Country:US
Mailing Address - Phone:756-234-0507
Mailing Address - Fax:775-588-9993
Practice Address - Street 1:50 E HASKELL ST STE C
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3576
Practice Address - Country:US
Practice Address - Phone:775-623-4050
Practice Address - Fax:775-623-0730
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist