Provider Demographics
NPI:1649365230
Name:FELLOWS, SCOTT H (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:H
Last Name:FELLOWS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3117
Mailing Address - Country:US
Mailing Address - Phone:570-622-3501
Mailing Address - Fax:570-622-2720
Practice Address - Street 1:2223 W END AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1825
Practice Address - Country:US
Practice Address - Phone:570-622-3501
Practice Address - Fax:570-622-2720
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024054L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice