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General NPI Number Information
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NPI Number | 1023136454
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Entity Type | Individual
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Provider Name | SCOTT WALTER STUDERUS DDS
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5122 OLYMPIC DR NW B-104
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City | GIG HARBOR
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State | WA
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Zip | 98335-1767
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Country | US
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Telephone | 253-851-2249
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Fax | 253-851-2204
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Provider Business Mailing Address
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Address Line | 9701 HARPER HILL RD SE
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City | PORT ORCHARD
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State | WA
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Zip | 98366-8973
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Country | US
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Telephone | 253-851-2249
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Fax | 253-851-2204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE00010603
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License Number State | WA
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