Provider Demographics
NPI:1932351079
Name:THOMAS, SCOTT PORTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PORTER
Last Name:THOMAS
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 1:120 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-9535
Mailing Address - Country:US
Mailing Address - Phone:503-538-8860
Mailing Address - Fax:
Practice Address - Street 1:120 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OR
Practice Address - Zip Code:97115-9535
Practice Address - Country:US
Practice Address - Phone:503-538-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD73911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD7391OtherDENTAL LICENSE NUMBER