Provider Demographics
NPI:1124158209
Name:DICKSON, R SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:SCOTT
Last Name:DICKSON
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 1:2040 MURRAY HOLLADAY RD
Mailing Address - Street 2:#200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5185
Mailing Address - Country:US
Mailing Address - Phone:801-277-1424
Mailing Address - Fax:801-277-0724
Practice Address - Street 1:2040 MURRAY HOLLADAY RD
Practice Address - Street 2:#200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5185
Practice Address - Country:US
Practice Address - Phone:801-277-1424
Practice Address - Fax:801-277-0724
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143233-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice