Individual
DR. SCOTT ADDISON FAUVELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
134 MINEOLA BLVD FL 3, MINEOLA, NY 11501-3959
(516) 294-9696
(516) 294-3531
Mailing address
134 MINEOLA BLVD, MINEOLA, NY 11501
(516) 294-9696
(516) 294-3531
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
050443
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050443
NY STATE LICENSE NUMBER
NY
01
—
112366457
EMPLOYER TAX ID
NY
Enumeration date
05/22/2007
Last updated
11/26/2008
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