Provider Demographics
NPI:1013053487
Name:PRESCOTT, SERGE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERGE
Middle Name:A
Last Name:PRESCOTT
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 1:4161 TAMIAMI TRL
Mailing Address - Street 2:SUITE 3171
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-255-8500
Mailing Address - Fax:941-255-8503
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:SUITE 3171
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-255-8500
Practice Address - Fax:941-255-8503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355371223G0001X
FLDN193991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice