Healthcare Provider Details

I. General information

NPI: 1881212488
Provider Name (Legal Business Name): SCARLETT KETTWICH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39740 PLEASANT ST
SANDY OR
97055-6412
US

IV. Provider business mailing address

39740 PLEASANT ST
SANDY OR
97055-6412
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-8471
  • Fax:
Mailing address:
  • Phone: 503-655-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD11512
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: