Provider Demographics
NPI:1992111322
Name:SCOTT, MICHAEL LOUIS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5521
Mailing Address - Country:US
Mailing Address - Phone:727-314-4045
Mailing Address - Fax:727-442-3360
Practice Address - Street 1:209 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5521
Practice Address - Country:US
Practice Address - Phone:727-314-4045
Practice Address - Fax:727-442-3360
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23860122300000X
KY9480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist