Provider Demographics
NPI:1871647206
Name:SCOTT, STANLEY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOHN
Last Name:SCOTT
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 1:5020 LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5719
Mailing Address - Country:US
Mailing Address - Phone:716-627-7200
Mailing Address - Fax:716-627-7279
Practice Address - Street 1:5020 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5719
Practice Address - Country:US
Practice Address - Phone:716-627-7200
Practice Address - Fax:716-627-7279
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0316101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA114438OtherUNITED CONCORDIA
NY00613676Medicaid