Provider Demographics
NPI:1932207214
Name:SCOTT, RICHARD FRANK (DDS MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANK
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:203 S ZEEB ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8324
Mailing Address - Country:US
Mailing Address - Phone:734-994-1040
Mailing Address - Fax:734-994-3022
Practice Address - Street 1:203 S ZEEB ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8324
Practice Address - Country:US
Practice Address - Phone:734-994-1040
Practice Address - Fax:734-994-3022
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012713204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
711254OtherUNITED CONCORDIA
MI9758160540OtherBCBSM
MI3024220Medicaid
MI3024220Medicaid
MI9758160540OtherBCBSM