Healthcare Provider Details

I. General information

NPI: 1942474440
Provider Name (Legal Business Name): SCOTT L MATSON DMD, BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 N MAIN ST #3
NORTH LOGAN UT
84341-1547
US

IV. Provider business mailing address

3125 N MAIN ST #3
NORTH LOGAN UT
84341-1547
US

V. Phone/Fax

Practice location:
  • Phone: 435-239-7212
  • Fax: 435-535-2464
Mailing address:
  • Phone: 435-239-7212
  • Fax: 435-535-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS037272
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8227102-9924
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: