Provider Demographics
NPI:1932104783
Name:HEBERT, SCOTT ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:HEBERT
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 1:2 DEERHURST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-6028
Mailing Address - Country:US
Mailing Address - Phone:210-922-3483
Mailing Address - Fax:210-598-5288
Practice Address - Street 1:125 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1650
Practice Address - Country:US
Practice Address - Phone:210-922-3483
Practice Address - Fax:210-598-5288
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126722102Medicaid
TX840747OtherBCBS FEDERAL EMPLOYEES
TX38644OtherUNITED HEALTHCARE INS.
TX695123OtherUNITED CONCORDIA INSURANC
TX007874OtherDELTA INSURANCE