MEDICARE: DR. SCOTT RONALD STANFIELD DMD

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	8008833-9922	UT

General Provider Information

NPI Number	:	1811284532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT RONALD STANFIELD DMD

Provider Business Mailing Address
First Line	:	PO BOX 786
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-0786
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	575 E 4500 S STE B220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4515
Country	:	US
Telephone Number	:	801-261-3622
Fax Number	:

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

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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