Provider Demographics
NPI:1962763136
Name:RALPH, SCOTT (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:RALPH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23505 E APPLEWAY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6003
Mailing Address - Country:US
Mailing Address - Phone:509-892-9284
Mailing Address - Fax:509-892-4005
Practice Address - Street 1:23505 E APPLEWAY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6003
Practice Address - Country:US
Practice Address - Phone:509-892-9284
Practice Address - Fax:509-892-4005
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA DE000082831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics