Provider Demographics
NPI:1326172396
Name:SCOTT W RALPH, DDS MS PS
Entity Type:Organization
Organization Name:SCOTT W RALPH, DDS MS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RALPH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:509-892-9284
Mailing Address - Street 1:22910 E APPLEWAY AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8605
Mailing Address - Country:US
Mailing Address - Phone:509-892-9284
Mailing Address - Fax:509-892-4005
Practice Address - Street 1:22910 E APPLEWAY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8605
Practice Address - Country:US
Practice Address - Phone:509-892-9284
Practice Address - Fax:509-892-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000082831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty