Provider Demographics
NPI:1306016902
Name:DEXTER, SCOTT RILEY (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RILEY
Last Name:DEXTER
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 1:309 RIALTO CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5232
Mailing Address - Country:US
Mailing Address - Phone:909-800-3818
Mailing Address - Fax:
Practice Address - Street 1:226 SELBY RANCH RD
Practice Address - Street 2:APT. # 8
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5829
Practice Address - Country:US
Practice Address - Phone:909-800-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA552421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice