Provider Demographics
NPI:1881146595
Name:SCOTT ENDODONTICS
Entity type:Organization
Organization Name:SCOTT ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-240-0649
Mailing Address - Street 1:2503 BUSH RIDGE DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245
Mailing Address - Country:US
Mailing Address - Phone:502-240-0649
Mailing Address - Fax:502-240-0649
Practice Address - Street 1:2503 BUSH RIDGE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245
Practice Address - Country:US
Practice Address - Phone:502-240-0649
Practice Address - Fax:502-240-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty