Scott Edward Distefano, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

20261 Issued in TX

Practice address

3535 N 4TH St
Ste 303
Longview, TX 75605

Phone

(903) 759-4607

Fax

(903) 759-3626

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Scott Distefano DDS PLLC

  • General Practice Dentistry
  • Longview, TX
  • NPI 1114803483
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1861593014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N 4TH ST",
            "address_2": "STE 303",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-759-4607",
            "fax_number": "903-759-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N 4TH ST",
            "address_2": "STE 303",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "75605",
            "telephone_number": "903-759-4607",
            "fax_number": "903-759-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTEFANO",
        "first_name": "SCOTT",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "20261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Griffin Dickerson, MD
• Andrew Dickhute
• Lois Ann Dietrich, PT
• Callie Dimond, LPC ASSOCIATE
• John T Dipasquale, MD
• Distinct Home Health Care Inc
• Diversified Psychological Services
• Gavyn Shea Diviney, FNP-C
• Ashley Renee' Dixon, CRNA
• CH'Via Minyon Dixon

• General Practice Dentistry in Longview, TX
• Providers in Longview, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.