Provider Demographics
NPI:1255623054
Name:SCOTT, MAICE A (DDS)
Entity type:Individual
Prefix:
First Name:MAICE
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W NIFONG BLVD
Mailing Address - Street 2:STE 6-130
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5615
Mailing Address - Country:US
Mailing Address - Phone:573-874-1990
Mailing Address - Fax:
Practice Address - Street 1:1000 W NIFONG BLVD
Practice Address - Street 2:STE 6-130
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5615
Practice Address - Country:US
Practice Address - Phone:573-874-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009013823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist