Provider Demographics
NPI:1508064015
Name:SCOTT, DAVID WESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WESLEY
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 1:3221 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6107
Mailing Address - Country:US
Mailing Address - Phone:916-458-6331
Mailing Address - Fax:916-962-0520
Practice Address - Street 1:6600 MADISON AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0645
Practice Address - Country:US
Practice Address - Phone:916-962-2300
Practice Address - Fax:916-962-0520
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0311501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice