Provider Demographics
NPI:1215342282
Name:JAY D SCOTT DDS PC
Entity type:Organization
Organization Name:JAY D SCOTT DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-375-1965
Mailing Address - Street 1:3330 N UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4454
Mailing Address - Country:US
Mailing Address - Phone:801-375-1965
Mailing Address - Fax:801-375-1977
Practice Address - Street 1:3330 N UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4454
Practice Address - Country:US
Practice Address - Phone:801-375-1965
Practice Address - Fax:801-375-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5674148-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty