Provider Demographics
NPI:1134163033
Name:MCPHERSON, SCOTT CHARLES (DDS)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:CHARLES
Last Name:MCPHERSON
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 1:1801 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5063
Mailing Address - Country:US
Mailing Address - Phone:515-225-1316
Mailing Address - Fax:515-225-7362
Practice Address - Street 1:1801 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-5063
Practice Address - Country:US
Practice Address - Phone:515-225-1316
Practice Address - Fax:515-225-7362
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA79001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1182907Medicaid