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General NPI Number Information
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NPI Number | 1699078691
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Entity Type | Individual
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Provider Name | SCOTT CHARLES PUGH DDS
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Gender | Male
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 11136 MOSS LN
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City | NAMPA
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State | ID
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Zip | 83651
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Country | US
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Telephone | 208-466-0515
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Fax | 208-442-5338
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | NAMPA
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State | ID
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Zip | 83653-0009
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Country | US
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Telephone | 208-467-4431
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Fax | 208-466-5359
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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 | D-4628
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License Number State | ID
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