Individual
SCOTT STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
485 E ALAMEDA RD, POCATELLO, ID 83201-3609
(208) 904-3966
(208) 234-8056
Mailing address
485 E ALAMEDA RD, POCATELLO, ID 83201-3609
(208) 904-3966
(208) 234-8056
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4540
ID
1223G0001X
General Practice Dentistry
D-4540
ID
Other
Enumeration date
10/10/2013
Last updated
07/21/2022
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