Provider Demographics
NPI:1174671283
Name:TOBIAS, SCOTT G (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:TOBIAS
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 1:411 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-3688
Mailing Address - Country:US
Mailing Address - Phone:308-345-1510
Mailing Address - Fax:208-523-6419
Practice Address - Street 1:411 W 5TH ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3688
Practice Address - Country:US
Practice Address - Phone:308-345-1510
Practice Address - Fax:308-345-2211
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71251223G0001X
IDD20811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002585700Medicaid