Provider Demographics
NPI:1942474440
Name:MATSON, SCOTT L (DMD, BS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:MATSON
Suffix:
Gender:M
Credentials:DMD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 N MAIN ST
Mailing Address - Street 2:#3
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-1547
Mailing Address - Country:US
Mailing Address - Phone:435-239-7212
Mailing Address - Fax:435-535-2464
Practice Address - Street 1:3125 N MAIN ST
Practice Address - Street 2:#3
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1547
Practice Address - Country:US
Practice Address - Phone:435-239-7212
Practice Address - Fax:435-535-2464
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0372721223S0112X
UT8227102-99241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery