Provider Demographics
NPI:1336286152
Name:BURGESS, SCOT E (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:E
Last Name:BURGESS
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 1:710 SW HIGHLAND AVE
Mailing Address - Street 2:PO BOX 697
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3120
Mailing Address - Country:US
Mailing Address - Phone:541-923-7432
Mailing Address - Fax:
Practice Address - Street 1:710 SW HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3120
Practice Address - Country:US
Practice Address - Phone:541-923-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics