Provider Demographics
NPI:1881854123
Name:SCOTT, JONATHAN NEAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NEAL
Last Name:SCOTT
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 1:110 E. USTICK RD.
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646
Mailing Address - Country:US
Mailing Address - Phone:208-888-9399
Mailing Address - Fax:208-888-6115
Practice Address - Street 1:110 E. USTICK RD.
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-888-9399
Practice Address - Fax:208-888-6115
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD41451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice