Provider Demographics
NPI:1891124228
Name:ANDERSON, SCOTT DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:ANDERSON
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 1:306 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2404
Mailing Address - Country:US
Mailing Address - Phone:970-641-1397
Mailing Address - Fax:970-641-3262
Practice Address - Street 1:306 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2404
Practice Address - Country:US
Practice Address - Phone:970-641-1397
Practice Address - Fax:970-641-3262
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist