Provider Demographics
NPI:1457365579
Name:SCOTT, WILLIAM TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TODD
Last Name:SCOTT
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 1:803 N SUMNER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:50801-1350
Mailing Address - Country:US
Mailing Address - Phone:641-782-7587
Mailing Address - Fax:641-782-7587
Practice Address - Street 1:304 W LUCAS ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-3633
Practice Address - Country:US
Practice Address - Phone:641-782-7587
Practice Address - Fax:641-782-7587
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA77591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0118570Medicaid
IA656620OtherUCCI (UNITED CONCORDIA)
IA00302OtherWELLMARK/FED ID