1649258401 NPI number — DR. SCOTT WILLIAM GEORGE DMD

Table of content: DR. SCOTT WILLIAM GEORGE DMD (NPI 1649258401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649258401 NPI number — DR. SCOTT WILLIAM GEORGE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGE
Provider First Name:
SCOTT
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649258401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2415 NE 134TH ST STE 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98686-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-576-5066
Provider Business Mailing Address Fax Number:
360-576-5059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 NE 134TH ST STE 311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98686-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-576-5066
Provider Business Practice Location Address Fax Number:
360-576-5059
Provider Enumeration Date:
01/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  DE00010824 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223E0200X , with the licence number: D7554 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)