MEDICARE: SCOTT W RALPH, DDS MS PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DE00008283	WA

General Provider Information

NPI Number	:	1326172396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT W RALPH, DDS MS PS

Provider Business Mailing Address
First Line	:	22910 E APPLEWAY AVE
Second Line	:	SUITE 3
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-8605
Country	:	US
Telephone Number	:	509-892-9284
Fax Number	:	509-892-4005

Provider Business Practice Location Address
First Line	:	22910 E APPLEWAY AVE
Second Line	:	SUITE 3
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-8605
Country	:	US
Telephone Number	:	509-892-9284
Fax Number	:	509-892-4005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT W RALPH
Credential	:	DDS, MS
Telephone Number	:	509-892-9284

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	08/22/2020

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