Provider Demographics
NPI:1528243771
Name:SCOTT FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:SCOTT FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-665-2448
Mailing Address - Street 1:1101 BROADWAY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2835
Mailing Address - Country:US
Mailing Address - Phone:605-665-2448
Mailing Address - Fax:605-665-1404
Practice Address - Street 1:1101 BROADWAY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2835
Practice Address - Country:US
Practice Address - Phone:605-665-2448
Practice Address - Fax:605-665-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0639261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental