Provider Demographics
NPI:1952306169
Name:SCOTT, DEREK WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:WADE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 GREEN OAK PL
Mailing Address - Street 2:STE C
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2010
Mailing Address - Country:US
Mailing Address - Phone:281-358-3125
Mailing Address - Fax:281-358-3669
Practice Address - Street 1:1520 GREEN OAK PL
Practice Address - Street 2:STE C
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2010
Practice Address - Country:US
Practice Address - Phone:281-358-3125
Practice Address - Fax:281-358-3669
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX202311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice