Provider Demographics
NPI:1285246058
Name:SCOTT, COREY (DDS)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:SCOTT
Suffix:
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 1:2456 MOSTELLER ESTATE AVE SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-3409
Mailing Address - Country:US
Mailing Address - Phone:864-617-9016
Mailing Address - Fax:
Practice Address - Street 1:2290 US HIGHWAY 70 SE # 967A
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-5164
Practice Address - Country:US
Practice Address - Phone:864-617-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17721122300000X
390200000X
NC130141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program