Provider Demographics
NPI:1538157144
Name:HETZ, SCOTT K (DMD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:K
Last Name:HETZ
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 1:1899 L ST NW #300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036
Mailing Address - Country:US
Mailing Address - Phone:202-659-2552
Mailing Address - Fax:202-466-9256
Practice Address - Street 1:1899 L ST NW
Practice Address - Street 2:#300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-659-2552
Practice Address - Fax:202-466-9256
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-030245-L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics