Provider Demographics
NPI:1528223963
Name:PICKUP, ALAN SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SCOTT
Last Name:PICKUP
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 1:1905 HILAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2714
Mailing Address - Country:US
Mailing Address - Phone:208-678-1355
Mailing Address - Fax:208-678-9312
Practice Address - Street 1:1905 HILAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2714
Practice Address - Country:US
Practice Address - Phone:208-678-1355
Practice Address - Fax:208-678-9312
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD20161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice