Provider Demographics
NPI:1841275625
Name:SCOVILL, GERALD DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAVID
Last Name:SCOVILL
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:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:MN
Mailing Address - Zip Code:56098
Mailing Address - Country:US
Mailing Address - Phone:507-893-4811
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:MN
Practice Address - Zip Code:56098
Practice Address - Country:US
Practice Address - Phone:507-893-4811
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist