Provider Demographics
NPI:1922122266
Name:SCOTT, JON ERIC
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ERIC
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 HOLLOW BANKS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5181
Mailing Address - Country:US
Mailing Address - Phone:832-563-8207
Mailing Address - Fax:
Practice Address - Street 1:112 BAMMEL WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3527
Practice Address - Country:US
Practice Address - Phone:281-587-4900
Practice Address - Fax:281-440-4285
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1350472-07Medicaid
TX1350472-04Medicaid
TX1350472-05Medicaid
TX1350472-01Medicaid
TX1350472-06Medicaid