Healthcare Provider Details

I. General information

NPI: 1073198966
Provider Name (Legal Business Name): SCOTT W GEORGE DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 NE 20TH AVE STE 100
VANCOUVER WA
98686-1412
US

IV. Provider business mailing address

14400 NE 20TH AVE STE 100
VANCOUVER WA
98686-1412
US

V. Phone/Fax

Practice location:
  • Phone: 360-576-5066
  • Fax: 360-576-5059
Mailing address:
  • Phone: 360-576-5066
  • Fax: 360-576-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT WILLIAM GEORGE
Title or Position: OWNER
Credential: DMD
Phone: 360-771-5581