Scott C Stucki, DMD
Individual provider Active NPI General Practice Dentistry · Delta, UT
NPI 1144656323 · NPPES record last updated Sep 19, 2013
Key facts
- NPI
- 1144656323
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 93-267126-9922 (UT)
- Practice address
- 372 West Main
Delta, UT 84624 - Phone
- (435) 864-2120
- Fax
- (435) 864-4085
- NPI assigned
- Sep 19, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160504001509 | UT | Order and Referring Only - Dentist |
7113226655 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 93-267126-9922 | UT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Delta Family Dentistry | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 93-267126-9922 | UT | Yes |
Addresses
Primary practice location
372 West Main
Delta, UT 84624
Mailing address
P.O. Box 695
372 West Main
Delta, UT 84624
Phone (435) 864-2120
Other providers in Delta, UT
- Renae G. Singletary
- Alan Ross Smith
- Erin Nicole Sorenson
- Randy Dale Stinson
- Megan E Strand
- Topaz Counseling PLLC
- Stacia Topham
- Unified Healing Solutions
- Andrew Wankier
- White River Academy
All providers in Delta, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.