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General NPI Number Information
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NPI Number | 1972887255
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Entity Type | Organization
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Legal Business Name | SCOTT R DEXTER DDS
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 889 EMBARCADERO DR STE 201
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-4093
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Country | US
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Telephone | 916-933-6282
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Fax | 916-933-4834
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Provider Business Mailing Address
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Address Line | 889 EMBARCADERO DR STE 201
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-4093
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Country | US
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Telephone | 916-933-6282
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Fax | 916-933-4834
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Authorized Official
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Title or Position | DENTIST/CEO
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Name | DR. SCOTT R DEXTER
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Credential | D.D.S.
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Telephone | 909-800-3818
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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 | 55242
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License Number State | CA
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