Provider Demographics
NPI:1669523833
Name:CONDIE, SCOTT M (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:CONDIE
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 1:1757 E BASELINE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1533
Mailing Address - Country:US
Mailing Address - Phone:480-497-2000
Mailing Address - Fax:480-546-4111
Practice Address - Street 1:1757 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1533
Practice Address - Country:US
Practice Address - Phone:480-497-2000
Practice Address - Fax:480-516-4111
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice