Provider Demographics
NPI:1760678593
Name:LOISELLE, SCOTT ALLAN (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLAN
Last Name:LOISELLE
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 1:612 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4728
Mailing Address - Country:US
Mailing Address - Phone:541-265-8501
Mailing Address - Fax:
Practice Address - Street 1:612 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4728
Practice Address - Country:US
Practice Address - Phone:541-265-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice