Provider Demographics
NPI:1609998855
Name:LAW, SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:LAW
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 1:2223 N ALMOND
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2233
Mailing Address - Country:US
Mailing Address - Phone:480-231-7020
Mailing Address - Fax:480-704-2272
Practice Address - Street 1:16421 N TATUM BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3454
Practice Address - Country:US
Practice Address - Phone:602-992-1639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice