Provider Demographics
NPI:1013334242
Name:SCOTT, ROBERT WILLIAM (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
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 1:4146 CARMICHAEL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3634
Mailing Address - Country:US
Mailing Address - Phone:334-270-9924
Mailing Address - Fax:334-270-9904
Practice Address - Street 1:4146 CARMICHAEL RD
Practice Address - Street 2:SUITE D
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3634
Practice Address - Country:US
Practice Address - Phone:334-270-9924
Practice Address - Fax:334-270-9904
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist