Provider Demographics
NPI:1356565246
Name:HUSETH, SCOTT WARREN (DDS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:WARREN
Last Name:HUSETH
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 1:48 HANOVER LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7224
Mailing Address - Country:US
Mailing Address - Phone:530-343-0248
Mailing Address - Fax:530-343-0249
Practice Address - Street 1:48 HANOVER LANE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7224
Practice Address - Country:US
Practice Address - Phone:530-343-0248
Practice Address - Fax:530-343-0249
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist