Provider Demographics
NPI:1861654543
Name:WATSON, SCOTT (DMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WATSON
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 1:714 TITUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3900
Mailing Address - Country:US
Mailing Address - Phone:585-342-4220
Mailing Address - Fax:
Practice Address - Street 1:714 TITUS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3900
Practice Address - Country:US
Practice Address - Phone:585-342-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037983122300000X
PASTUDENT122300000X
NY0556571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist