Provider Demographics
NPI:1326126251
Name:DECKER, SCOTT CHRISTIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHRISTIAN
Last Name:DECKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 COLE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2637
Mailing Address - Country:US
Mailing Address - Phone:360-825-3191
Mailing Address - Fax:253-537-1371
Practice Address - Street 1:1120 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2637
Practice Address - Country:US
Practice Address - Phone:360-825-3191
Practice Address - Fax:253-537-1371
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000104241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice