Provider Demographics
NPI:1750577987
Name:NATALIE, ANTHONY SCOT (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:SCOT
Last Name:NATALIE
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 1:148 VESTAL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1277
Mailing Address - Country:US
Mailing Address - Phone:317-839-2381
Mailing Address - Fax:
Practice Address - Street 1:148 VESTAL RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1277
Practice Address - Country:US
Practice Address - Phone:317-839-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1760590517OtherBUSINESS ENTITY