Provider Demographics
NPI:1881650372
Name:NORTHEY, SCOTT RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RAYMOND
Last Name:NORTHEY
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 1:3516 PINTO DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55340-9608
Mailing Address - Country:US
Mailing Address - Phone:763-496-0284
Mailing Address - Fax:763-496-0282
Practice Address - Street 1:8414 FILLMORE ST NE
Practice Address - Street 2:NORTHEY DENTAL INC
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-1266
Practice Address - Country:US
Practice Address - Phone:763-496-0284
Practice Address - Fax:763-496-0282
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist