Provider Demographics
NPI:1972220291
Name:BRIAN SCOTT DDS MS PC
Entity Type:Organization
Organization Name:BRIAN SCOTT DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADM
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-545-2722
Mailing Address - Street 1:1641 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2062
Mailing Address - Country:US
Mailing Address - Phone:719-545-2722
Mailing Address - Fax:
Practice Address - Street 1:13 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3601
Practice Address - Country:US
Practice Address - Phone:719-545-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIAN SCOTT DDS MS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-26
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty