Provider Demographics
NPI:1306951074
Name:MT. SCOTT ENDODONTICS, PC
Entity type:Organization
Organization Name:MT. SCOTT ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:BAUMGARTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:503-698-4484
Mailing Address - Street 1:10365 SE SUNNYSIDE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5707
Mailing Address - Country:US
Mailing Address - Phone:503-698-4484
Mailing Address - Fax:503-698-5033
Practice Address - Street 1:10365 SE SUNNYSIDE RD STE 260
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5707
Practice Address - Country:US
Practice Address - Phone:503-698-4484
Practice Address - Fax:503-698-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7910261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental