Provider Demographics
NPI:1942387246
Name:BRUNDRETT, SCOTT A (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:BRUNDRETT
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 1:2310 BANKHEAD HWY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-5828
Mailing Address - Country:US
Mailing Address - Phone:770-832-1717
Mailing Address - Fax:
Practice Address - Street 1:2310 BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-5828
Practice Address - Country:US
Practice Address - Phone:770-832-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist