Provider Demographics
NPI:1356400857
Name:ANDERSON, SCOTT THOMAS (DDS PC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S RIVERVIEW
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:IA
Mailing Address - Zip Code:52031
Mailing Address - Country:US
Mailing Address - Phone:563-872-5678
Mailing Address - Fax:563-872-5678
Practice Address - Street 1:400 S RIVERVIEW
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:IA
Practice Address - Zip Code:52031
Practice Address - Country:US
Practice Address - Phone:563-872-5678
Practice Address - Fax:563-872-5678
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA73901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0056697Medicaid
860752OtherUNITED CONCORDIA
IA281188OtherDELTA OF IA