Provider Demographics
NPI:1114931722
Name:KISER, SCOTT (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KISER
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 1:2603 CRUISE BAY CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3260
Mailing Address - Country:US
Mailing Address - Phone:801-277-1010
Mailing Address - Fax:801-277-7016
Practice Address - Street 1:2240 E. MURRAY-HOLLADAY RD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-277-1010
Practice Address - Fax:801-277-7016
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142240-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice