Provider Demographics
NPI:1851509657
Name:DICKSON, SCOTT SHELDON (DMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:SHELDON
Last Name:DICKSON
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 1:690 N MERIDIAN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3586
Mailing Address - Country:US
Mailing Address - Phone:406-755-3636
Mailing Address - Fax:406-755-3638
Practice Address - Street 1:690 N MERIDIAN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3586
Practice Address - Country:US
Practice Address - Phone:406-755-3636
Practice Address - Fax:406-755-3638
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics