Provider Demographics
NPI:1205965548
Name:SCOTT, PATRICIA ANNETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BERINGER CIR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-2280
Mailing Address - Country:US
Mailing Address - Phone:217-337-1377
Mailing Address - Fax:217-337-1322
Practice Address - Street 1:406 BERINGER CIR
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-2280
Practice Address - Country:US
Practice Address - Phone:217-337-1377
Practice Address - Fax:217-337-1322
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223D0001XDental ProvidersDentistDental Public Health
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003669Medicaid
IL101248Medicaid