Healthcare Provider Details

I. General information

NPI: 1417891524
Provider Name (Legal Business Name): JASON R. SCOTT DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12109 E BROADWAY AVE STE B
SPOKANE VALLEY WA
99206-6133
US

IV. Provider business mailing address

12109 E BROADWAY AVE STE B
SPOKANE VALLEY WA
99206-6133
US

V. Phone/Fax

Practice location:
  • Phone: 509-926-0570
  • Fax:
Mailing address:
  • Phone: 509-926-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: CASSANDRA WIETH
Title or Position: DIRECTOR OF PAYOR RELATIONS
Credential:
Phone: 623-267-8121