Provider Demographics
NPI:1932550977
Name:SCOTT, KALI (RDH)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 SW DELAWARE CIR
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8213
Mailing Address - Country:US
Mailing Address - Phone:541-749-8274
Mailing Address - Fax:
Practice Address - Street 1:7306 SW DELAWARE CIR
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8213
Practice Address - Country:US
Practice Address - Phone:541-749-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7087124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist