Provider Demographics
NPI:1457556813
Name:THEURER, SCOTT L (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:THEURER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N 600 E
Mailing Address - Street 2:STE 1
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2440
Mailing Address - Country:US
Mailing Address - Phone:435-752-2230
Mailing Address - Fax:435-752-6481
Practice Address - Street 1:1340 N 600 E
Practice Address - Street 2:STE 1
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2440
Practice Address - Country:US
Practice Address - Phone:435-752-2230
Practice Address - Fax:435-752-6481
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142169-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice