Provider Demographics
NPI:1295147031
Name:ENGLE, SCOTT ELIOT (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ELIOT
Last Name:ENGLE
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 1:1357 N GREAT NECK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2237
Mailing Address - Country:US
Mailing Address - Phone:757-481-5900
Mailing Address - Fax:757-222-1010
Practice Address - Street 1:2404 POTTERS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4335
Practice Address - Country:US
Practice Address - Phone:757-340-8805
Practice Address - Fax:757-340-8803
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014144351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice