Healthcare Provider Details

I. General information

NPI: 1861507246
Provider Name (Legal Business Name): SCOTT EDWARD THOMSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 TUDOR CENTRE DR
ANCHORAGE AK
99508-5904
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2000
  • Fax:
Mailing address:
  • Phone: 907-729-8901
  • Fax: 907-729-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3680
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number181727
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: