Provider Demographics
NPI:1174738934
Name:GRASSO, SCOTT A (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:GRASSO
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 1:3212 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4314
Mailing Address - Country:US
Mailing Address - Phone:765-287-8040
Mailing Address - Fax:765-282-9332
Practice Address - Street 1:3212 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4314
Practice Address - Country:US
Practice Address - Phone:765-287-8040
Practice Address - Fax:765-282-9332
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist