Healthcare Provider Details

I. General information

NPI: 1396766036
Provider Name (Legal Business Name): SCOTT T SIMPSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16035 SW PACIFIC HWY
TIGARD OR
97224-3438
US

IV. Provider business mailing address

16035 SW PACIFIC HWY
TIGARD OR
97224-3438
US

V. Phone/Fax

Practice location:
  • Phone: 503-620-2185
  • Fax: 503-670-4863
Mailing address:
  • Phone: 503-620-2185
  • Fax: 503-670-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: