Provider Demographics
NPI:1699883520
Name:CHANDLER, SCOTT M (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:CHANDLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E 2700 N
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9654
Mailing Address - Country:US
Mailing Address - Phone:801-362-5929
Mailing Address - Fax:435-649-0654
Practice Address - Street 1:3080 PINEBROOK RD STE 2000
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5451
Practice Address - Country:US
Practice Address - Phone:801-465-1810
Practice Address - Fax:801-465-1810
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7526337-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806034600Medicaid