Provider Demographics
NPI:1720176084
Name:MARCUM, SCOOT LEWIS SR (DDS)
Entity Type:Individual
Prefix:
First Name:SCOOT
Middle Name:LEWIS
Last Name:MARCUM
Suffix:SR
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 1:6975 SAN LUIS AVE
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5201
Mailing Address - Country:US
Mailing Address - Phone:805-461-6682
Mailing Address - Fax:805-461-6681
Practice Address - Street 1:6975 SAN LUIS AVE
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5201
Practice Address - Country:US
Practice Address - Phone:805-461-6682
Practice Address - Fax:805-461-6681
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics