Provider Demographics
NPI:1437387305
Name:CLAIBORNE, SCOTT TILSON (DDS, MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:TILSON
Last Name:CLAIBORNE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 S BROAD ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6601
Mailing Address - Country:US
Mailing Address - Phone:203-639-0800
Mailing Address - Fax:
Practice Address - Street 1:546 S BROAD ST STE 2A
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6601
Practice Address - Country:US
Practice Address - Phone:203-639-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT118451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery