Provider Demographics
NPI:1255615985
Name:SCOTT STUDERUS DDS PS
Entity type:Organization
Organization Name:SCOTT STUDERUS DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:STUDERUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-850-8500
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0985
Mailing Address - Country:US
Mailing Address - Phone:360-275-9300
Mailing Address - Fax:360-275-9315
Practice Address - Street 1:131 NE ROY BOAD RD UNIT C
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-8649
Practice Address - Country:US
Practice Address - Phone:360-275-9300
Practice Address - Fax:360-275-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty