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General NPI Number Information
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NPI Number | 1306951074
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Entity Type | Organization
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Legal Business Name | MT. SCOTT ENDODONTICS, PC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10365 SE SUNNYSIDE RD STE 260
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City | CLACKAMAS
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State | OR
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Zip | 97015-5707
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Country | US
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Telephone | 503-698-4484
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Fax | 503-698-5033
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Provider Business Mailing Address
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Address Line | 10365 SE SUNNYSIDE RD STE 260
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City | CLACKAMAS
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State | OR
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Zip | 97015-5707
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Country | US
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Telephone | 503-698-4484
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Fax | 503-698-5033
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Authorized Official
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Title or Position | PRESIDENT/ENDODONTIST
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Name | DR. MATTHEW RALPH BAUMGARTH
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Credential | D.D.S., M.S.
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Telephone | 503-698-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D7910
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License Number State | OR
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