Provider Demographics
NPI:1083400154
Name:SCOTT C DECKER, DMD, PLLC
Entity type:Organization
Organization Name:SCOTT C DECKER, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-825-3191
Mailing Address - Street 1:1120 COLE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2637
Mailing Address - Country:US
Mailing Address - Phone:360-825-3191
Mailing Address - Fax:360-802-4785
Practice Address - Street 1:1120 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2637
Practice Address - Country:US
Practice Address - Phone:360-825-3191
Practice Address - Fax:360-802-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental