MEDICARE: SCOTT WALETZKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE 60045256	WA

General Provider Information

NPI Number	:	1205161825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT WALETZKO

Provider Business Mailing Address
First Line	:	275 SE CABOT DR STE B204
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3755
Country	:	US
Telephone Number	:	360-675-2284
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 SE CABOT DR
Second Line	:	SUITE B-204
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3715
Country	:	US
Telephone Number	:	360-675-2284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	03/23/2026

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Directions to “ SCOTT WALETZKO ” Practice Location

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