Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 30-021139 | OH |
N | 204E00000X | Oral & Maxillofacial Surgeon | 30-021139 | OH |
NPI | 1215998851 |
---|---|
Provider Name | Scott A. Puckett |
First Address | Wilmington, OH 45177 |
Second Address | Wilmington, OH 45177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |