Scott Codwise Dickinson
Individual provider Active NPI General Practice Dentistry · De Witt, NY
NPI 1942432729 · NPPES record last updated Aug 13, 2009
Key facts
- NPI
- 1942432729
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 047959 (NY)
- Practice address
- 3425 Erie Blvd E
De Witt, NY 13214-1635 - Phone
- (315) 445-9400
- Fax
- (315) 445-4030
- NPI assigned
- Aug 13, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160413002125 | FL | Order and Referring Only - Dentist |
6103124821 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047959 | NY | MD | General Practice Dentistry |
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 047959 | NY | Yes |
Addresses
Primary practice location
3425 Erie Blvd E
De Witt, NY 13214-1635
Mailing address
PO Box 3189
Syracuse, NY 13220-3189
Phone (315) 454-6000
Other providers in De Witt, NY
- Carlton P Cooke III
- Katie Curran IV
- Susan E Davoli
- Wendy Decker
- Elizabeth Defreitas
- Olesya Alexis Dmytryk
- Alexa Brady Ellingsen Roehrig
- John F Fatti
- Fitness Forum Physical and Occupational Therapy, PLLC
- Judith K Flint
All providers in De Witt, NY · General Practice Dentistry in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.