Provider Demographics
NPI:1780847103
Name:NEUHAUS, SCOTT JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOHN
Last Name:NEUHAUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 PACIFIC AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1108
Mailing Address - Country:US
Mailing Address - Phone:360-491-0804
Mailing Address - Fax:360-456-0966
Practice Address - Street 1:3925 PACIFIC AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1108
Practice Address - Country:US
Practice Address - Phone:360-491-0804
Practice Address - Fax:360-456-0966
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5744122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist