Provider Demographics
NPI:1245319318
Name:MCCUNE, T SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:T
Middle Name:SCOTT
Last Name:MCCUNE
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 1:4800 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7666
Mailing Address - Country:US
Mailing Address - Phone:330-725-8794
Mailing Address - Fax:330-723-9674
Practice Address - Street 1:4800 LEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7666
Practice Address - Country:US
Practice Address - Phone:330-725-8794
Practice Address - Fax:330-723-9674
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300190621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice