Provider Demographics
NPI:1720366149
Name:CRANE, SCOTT DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:CRANE
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 1:12622 TATOOSH RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2992
Mailing Address - Country:US
Mailing Address - Phone:253-970-7677
Mailing Address - Fax:
Practice Address - Street 1:716 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-2847
Practice Address - Country:US
Practice Address - Phone:360-736-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602338211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice