Provider Demographics
NPI:1699935353
Name:ALLEN, SCOTT T (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:ALLEN
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 1:3815 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7591
Mailing Address - Country:US
Mailing Address - Phone:208-529-4500
Mailing Address - Fax:208-524-6248
Practice Address - Street 1:3815 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7591
Practice Address - Country:US
Practice Address - Phone:208-529-4500
Practice Address - Fax:208-524-6248
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-41521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice