Provider Demographics
NPI:1700931052
Name:ANDERSEN, SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:ANDERSEN
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 1:4850 W PANTHER CREEK DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3607
Mailing Address - Country:US
Mailing Address - Phone:281-292-4242
Mailing Address - Fax:281-298-8090
Practice Address - Street 1:4850 W PANTHER CREEK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3607
Practice Address - Country:US
Practice Address - Phone:281-292-4242
Practice Address - Fax:281-298-8090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry