Provider Demographics
NPI:1700416922
Name:RAWLS, SCOTT MCNEAL
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MCNEAL
Last Name:RAWLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2836
Mailing Address - Country:US
Mailing Address - Phone:907-227-3546
Mailing Address - Fax:
Practice Address - Street 1:1724 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2836
Practice Address - Country:US
Practice Address - Phone:907-227-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician