Provider Demographics
NPI:1528105061
Name:SCOTT, IRA LEWIS SR (DDS)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:LEWIS
Last Name:SCOTT
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 MASSACHUSETTS AVE NW STE 316
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4382
Mailing Address - Country:US
Mailing Address - Phone:202-686-1843
Mailing Address - Fax:202-686-5391
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW STE 316
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4382
Practice Address - Country:US
Practice Address - Phone:202-686-1843
Practice Address - Fax:202-686-5391
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN29331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC521861090OtherTIN