Provider Demographics
NPI:1003308388
Name:SCOTT, ALEX WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:WILLIAM
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 EDEN PRAIRIE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-938-6038
Mailing Address - Fax:952-935-9175
Practice Address - Street 1:5509 EDEN PRAIRIE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345
Practice Address - Country:US
Practice Address - Phone:952-938-6038
Practice Address - Fax:952-935-9175
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010034122300000X
MND14628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist