Provider Demographics
NPI:1487110813
Name:KEVIN SCOTTI DDS
Entity type:Organization
Organization Name:KEVIN SCOTTI DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-702-0794
Mailing Address - Street 1:520 12TH ST S APT 1805
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4279
Mailing Address - Country:US
Mailing Address - Phone:317-702-0794
Mailing Address - Fax:
Practice Address - Street 1:3801 FAIRFAX DR STE 70
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:703-465-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental