Healthcare Provider Details

I. General information

NPI: 1649258401
Provider Name (Legal Business Name): SCOTT WILLIAM GEORGE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 NE 134TH ST STE 311
VANCOUVER WA
98686-3025
US

IV. Provider business mailing address

2415 NE 134TH ST STE 311
VANCOUVER WA
98686-3025
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 NumberDE00010824
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD7554
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: