Provider Demographics
NPI:1073198966
Name:SCOTT W GEORGE DMD PLLC
Entity Type:Organization
Organization Name:SCOTT W GEORGE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-771-5581
Mailing Address - Street 1:14400 NE 20TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1412
Mailing Address - Country:US
Mailing Address - Phone:360-576-5066
Mailing Address - Fax:360-576-5059
Practice Address - Street 1:14400 NE 20TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1412
Practice Address - Country:US
Practice Address - Phone:360-576-5066
Practice Address - Fax:360-576-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty