Provider Demographics
NPI:1932803186
Name:SCOTT, EDWIN WILL HARRIS (DMD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:WILL HARRIS
Last Name:SCOTT
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 1:1501 HERMAN ST APT 405
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3557
Mailing Address - Country:US
Mailing Address - Phone:225-450-4501
Mailing Address - Fax:
Practice Address - Street 1:1007 NASHVILLE PIKE STE 100
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3703
Practice Address - Country:US
Practice Address - Phone:615-989-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN12266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program