Provider Demographics
NPI:1376613000
Name:R SCOTT PUHN DDS PS
Entity Type:Organization
Organization Name:R SCOTT PUHN DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PUHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS DOCTOR OF DENTAL
Authorized Official - Phone:360-779-9090
Mailing Address - Street 1:20730 BOND RD NE
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-779-9090
Mailing Address - Fax:360-779-9106
Practice Address - Street 1:20730 BOND RD NE
Practice Address - Street 2:SUITE 202B
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-779-9090
Practice Address - Fax:360-779-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5517909Medicaid
WA836940OtherUNITED CONCORDIA
WA94276OtherDELTA DENTAL
WA5027OtherWDS
WA94276OtherDELTA DENTAL