Provider Demographics
NPI:1023136454
Name:STUDERUS, SCOTT WALTER (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WALTER
Last Name:STUDERUS
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 1:9701 HARPER HILL RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8973
Mailing Address - Country:US
Mailing Address - Phone:253-851-2249
Mailing Address - Fax:253-851-2204
Practice Address - Street 1:5122 OLYMPIC DR NW
Practice Address - Street 2:B-104
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1767
Practice Address - Country:US
Practice Address - Phone:253-851-2249
Practice Address - Fax:253-851-2204
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000106031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice