Provider Demographics
NPI:1154367449
Name:POWERS, SCOTT W (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:POWERS
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IN
Mailing Address - Zip Code:47443-0236
Mailing Address - Country:US
Mailing Address - Phone:812-659-3901
Mailing Address - Fax:812-659-3903
Practice Address - Street 1:195 E BROAD ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:IN
Practice Address - Zip Code:47443-0236
Practice Address - Country:US
Practice Address - Phone:812-659-3901
Practice Address - Fax:812-659-3903
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120100621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN352116058001OtherANTHEM FEDERAL EMPLOYEE