Provider Demographics
NPI:1528572682
Name:SCOTT, SANDRA JO (RDH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JO
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:JO
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:264 W RIDGELINE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TERRACE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:264 W RIDGELINE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-624-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT374964-0701124Q00000X
UT374964-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist