Provider Demographics
NPI:1952460339
Name:ROLLISON, SCOTT R (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:ROLLISON
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 1:1071 DAY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-5301
Mailing Address - Country:US
Mailing Address - Phone:607-770-9898
Mailing Address - Fax:
Practice Address - Street 1:12 BEECH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1019
Practice Address - Country:US
Practice Address - Phone:607-770-9898
Practice Address - Fax:607-770-9025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048928-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics