Provider Demographics
NPI:1972707131
Name:SCOTT, JESSIE BETH (DDS)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:BETH
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 BURGESS RD
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4903
Mailing Address - Country:US
Mailing Address - Phone:605-660-8416
Mailing Address - Fax:
Practice Address - Street 1:1101 BROADWAY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2835
Practice Address - Country:US
Practice Address - Phone:605-665-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD0639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist