Provider Demographics
NPI:1831481530
Name:NILE G SCOTT DDS PC
Entity Type:Organization
Organization Name:NILE G SCOTT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NILE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-545-2722
Mailing Address - Street 1:1641 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2062
Mailing Address - Country:US
Mailing Address - Phone:719-545-2722
Mailing Address - Fax:719-545-7427
Practice Address - Street 1:1641 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-2062
Practice Address - Country:US
Practice Address - Phone:719-545-2722
Practice Address - Fax:719-545-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO-01121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty