Provider Demographics
NPI:1770973943
Name:SCOTT, MALLORY GROVES (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:GROVES
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BURNSIDE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-3779
Mailing Address - Country:US
Mailing Address - Phone:843-379-9200
Mailing Address - Fax:
Practice Address - Street 1:1600 BURNSIDE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-3779
Practice Address - Country:US
Practice Address - Phone:843-379-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4410/7251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics