Scot F Brechon, DDS
Individual provider Active NPI Dentist · Ottumwa, IA
NPI 1366525925 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366525925
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7691 (IA)
- Practice address
- 1302 N Elm St
Ottumwa, IA 52504 - Phone
- (641) 684-8635
- Fax
- (641) 684-0686
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7691 | IA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hammer and Brechon DDS PC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7691 | IA | Yes |
Addresses
Primary practice location
1302 N Elm St
Ottumwa, IA 52504
Mailing address
1302 N Elm St
Ottumwa, IA 52504
Phone (641) 684-8635
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52241 | Other | IA | BLUE CROSS BLUE SHIELD |
| 0105569 | Medicaid | IA |
Other providers in Ottumwa, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.