Provider Demographics
NPI:1962680066
Name:BRYAN M. SCOTT, DDS, INC.
Entity Type:Organization
Organization Name:BRYAN M. SCOTT, DDS, INC.
Other - Org Name:BRYAN M. SCOTT, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-899-9001
Mailing Address - Street 1:1790 TOWN PARK BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7972
Mailing Address - Country:US
Mailing Address - Phone:330-899-9001
Mailing Address - Fax:330-899-9006
Practice Address - Street 1:1790 TOWN PARK BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7972
Practice Address - Country:US
Practice Address - Phone:330-899-9001
Practice Address - Fax:330-899-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0209841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U56315Medicare UPIN