Provider Demographics
NPI:1972726859
Name:ANDERSEN, W. SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:W. SCOTT
Middle Name:
Last Name:ANDERSEN
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:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:UT
Mailing Address - Zip Code:84715-0320
Mailing Address - Country:US
Mailing Address - Phone:435-425-3391
Mailing Address - Fax:435-425-3202
Practice Address - Street 1:374 S. 300 E.
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:UT
Practice Address - Zip Code:84715-0320
Practice Address - Country:US
Practice Address - Phone:435-425-3391
Practice Address - Fax:435-425-3202
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT541803089031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice