Provider Demographics
NPI:1831759174
Name:HOWARD SCOTT, CANISHA (DDS)
Entity type:Individual
Prefix:DR
First Name:CANISHA
Middle Name:
Last Name:HOWARD SCOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 DULUTH HWY # 103
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5010
Mailing Address - Country:US
Mailing Address - Phone:770-338-1963
Mailing Address - Fax:
Practice Address - Street 1:1699 DULUTH HWY UNIT 103
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5010
Practice Address - Country:US
Practice Address - Phone:770-338-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN016161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program