Provider Demographics
NPI:1992052401
Name:SHAKESPEAR, SCOTT HALL (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:HALL
Last Name:SHAKESPEAR
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 1:862 S ASPEN LOOP
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6466
Mailing Address - Country:US
Mailing Address - Phone:480-432-5852
Mailing Address - Fax:
Practice Address - Street 1:310 N 400 E
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1558
Practice Address - Country:US
Practice Address - Phone:435-623-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0084631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice