Healthcare Provider Details

I. General information

NPI: 1003222506
Provider Name (Legal Business Name): SCOTT PICKETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 EAGLE DR
AMMON ID
83406-5769
US

IV. Provider business mailing address

2805 EAGLE DR
AMMON ID
83406-5769
US

V. Phone/Fax

Practice location:
  • Phone: 208-542-1333
  • Fax: 208-467-5100
Mailing address:
  • Phone: 208-542-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD4669-PD
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: