Provider Demographics
NPI:1811047277
Name:FEDERSPILL, SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FEDERSPILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:FEDERSPILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:9201 N MERIDIAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1852
Mailing Address - Country:US
Mailing Address - Phone:317-580-1880
Mailing Address - Fax:
Practice Address - Street 1:9201 N MERIDIAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1852
Practice Address - Country:US
Practice Address - Phone:317-580-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120093491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice