Provider Demographics
NPI:1881981074
Name:HUYNH, SCOTT LIEM (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LIEM
Last Name:HUYNH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4336 HALE DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4114
Mailing Address - Country:US
Mailing Address - Phone:404-819-8267
Mailing Address - Fax:
Practice Address - Street 1:6568 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1228
Practice Address - Country:US
Practice Address - Phone:770-961-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0142941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice