Provider Demographics
NPI:1154380772
Name:STEIN, SCOTT RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RAYMOND
Last Name:STEIN
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 1:3920 S 1100 E
Mailing Address - Street 2:#370
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1213
Mailing Address - Country:US
Mailing Address - Phone:801-268-3516
Mailing Address - Fax:801-268-3533
Practice Address - Street 1:3920 S 1100 E
Practice Address - Street 2:#370
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1213
Practice Address - Country:US
Practice Address - Phone:801-268-3516
Practice Address - Fax:801-268-3533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT321944-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice