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General NPI Number Information
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NPI Number | 1497749881
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Entity Type | Individual
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Provider Name | SCOTT W EDGAR DMD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1020 NE 2ND AVE #320
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City | PORTLAND
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State | OR
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Zip | 97232-2064
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Country | US
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Telephone | 503-231-0882
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Fax | 503-231-9419
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Provider Business Mailing Address
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Address Line | 2414 NE 32ND AVE
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City | PORTLAND
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State | OR
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Zip | 97212-4933
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Country | US
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Telephone | 503-235-5796
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Fax |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D6981
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License Number State | OR
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