Provider Demographics
NPI:1184774499
Name:NIETTE, SCOTT ALBERT (DMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALBERT
Last Name:NIETTE
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:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:GA
Mailing Address - Zip Code:31006-0670
Mailing Address - Country:US
Mailing Address - Phone:478-862-5954
Mailing Address - Fax:478-862-5957
Practice Address - Street 1:43 SOUTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:GA
Practice Address - Zip Code:31006
Practice Address - Country:US
Practice Address - Phone:478-862-5954
Practice Address - Fax:478-862-5957
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist