Provider Demographics
NPI:1538293675
Name:DAY, SCOTT R (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:DAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:354 EAST MAIN STREET
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-0427
Mailing Address - Country:US
Mailing Address - Phone:315-287-4000
Mailing Address - Fax:315-287-4109
Practice Address - Street 1:354 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1512
Practice Address - Country:US
Practice Address - Phone:315-287-4000
Practice Address - Fax:315-287-4109
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0408621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01134569Medicaid