Provider Demographics
NPI:1871675371
Name:MCGAVIN, SCOTT KELSEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KELSEY
Last Name:MCGAVIN
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 1:6243 S REDWOOD RD
Mailing Address - Street 2:#220
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6411
Mailing Address - Country:US
Mailing Address - Phone:801-293-8740
Mailing Address - Fax:801-293-8589
Practice Address - Street 1:6243 S REDWOOD RD
Practice Address - Street 2:#220
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-6411
Practice Address - Country:US
Practice Address - Phone:801-293-8740
Practice Address - Fax:801-293-8589
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144913-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice