Provider Demographics
NPI:1104950898
Name:GRASLIE, SCOTT A (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:GRASLIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783
Mailing Address - Country:US
Mailing Address - Phone:605-642-2644
Mailing Address - Fax:605-722-0057
Practice Address - Street 1:830 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2184
Practice Address - Country:US
Practice Address - Phone:605-642-2644
Practice Address - Fax:605-722-0057
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7809990Medicaid