Provider Demographics
NPI:1336391291
Name:ALPEN, SCOTT ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:ALPEN
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 1:3575 JERSEY RIDGE ROAD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2292
Mailing Address - Country:US
Mailing Address - Phone:563-322-4433
Mailing Address - Fax:563-355-5026
Practice Address - Street 1:3575 JERSEY RIDGE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2292
Practice Address - Country:US
Practice Address - Phone:563-322-4433
Practice Address - Fax:563-355-5026
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA73041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0048157Medicaid
IA26018OtherBLUE CROSS BLUE SHEILD
888977OtherUNITED CONCORDIA