Provider Demographics
NPI:1366525925
Name:BRECHON, SCOT F (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOT
Middle Name:F
Last Name:BRECHON
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 1:1302 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52504
Mailing Address - Country:US
Mailing Address - Phone:641-684-8635
Mailing Address - Fax:641-684-0686
Practice Address - Street 1:1302 N ELM ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52504
Practice Address - Country:US
Practice Address - Phone:641-684-8635
Practice Address - Fax:641-684-0686
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA52241OtherBLUE CROSS BLUE SHIELD
IA0105569Medicaid