Provider Demographics
NPI:1477669570
Name:SCOTT, RONALD KENT (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KENT
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 1:119 BELKNAP ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2925
Mailing Address - Country:US
Mailing Address - Phone:715-392-5131
Mailing Address - Fax:715-392-9645
Practice Address - Street 1:119 BELKNAP ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2925
Practice Address - Country:US
Practice Address - Phone:715-392-5131
Practice Address - Fax:715-392-9645
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1127G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33542300Medicaid