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Individual

SCOTT D DAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
3315 S HOLMES AVE, IDAHO FALLS, ID 83404
(208) 522-4491
(208) 522-4662
Mailing address
3315 S HOLMES AVE, IDAHO FALLS, ID 83404
(208) 522-4491
(208) 522-4662

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1797
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010009403
BLUE SHIELD OF IDAHO
ID
01
6D980
BLUE CROSS OF IDAHO
ID
01
853815
UNITED CONCORDIA
Enumeration date
10/02/2006
Last updated
07/08/2007
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