Provider Demographics
NPI:1679609523
Name:UPDYKE, M. SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:SCOTT
Last Name:UPDYKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 S 2300 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3019
Mailing Address - Country:US
Mailing Address - Phone:801-484-5048
Mailing Address - Fax:801-484-8918
Practice Address - Street 1:3369 S 2300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-3019
Practice Address - Country:US
Practice Address - Phone:801-484-5048
Practice Address - Fax:801-484-8918
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT143716-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice