Provider Demographics
NPI:1679692461
Name:SCOTT, CARLEY JEFF (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLEY
Middle Name:JEFF
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 2ND AVE S # 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4312
Mailing Address - Country:US
Mailing Address - Phone:727-420-7944
Mailing Address - Fax:727-898-8588
Practice Address - Street 1:239 2ND AVE S # 100
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4312
Practice Address - Country:US
Practice Address - Phone:727-420-7944
Practice Address - Fax:727-898-8585
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL116931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice