Active NPI
Scott S Probst, DDS
- Dentist
- Tacoma, WA
National Provider Identifier
1508050923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE 60178653
- Practice address
- 3820 Pacific Ave
Suite 101
Tacoma, WA 98418-7825 - Phone
- (253) 472-3006
- Fax
- (253) 472-3011
- NPI assigned
- Aug 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9475DDS | CO | |
| Dentist | 122300000X | DE 60178653 | WA | Primary |
Addresses
Primary practice location
3820 Pacific Ave
Suite 101
Tacoma, WA 98418-7825
Mailing address
3820 Pacific Ave
Suite 101
Tacoma, WA 98418-7825
Phone (253) 472-3006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9475DDS | CO | MD | Dentist |
| DE 60178653 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Tacoma Dental PLLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308528000000",
"number": "1508050923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3820 PACIFIC AVE",
"address_2": "SUITE 101",
"city": "TACOMA",
"state": "WA",
"postal_code": "984187825",
"telephone_number": "253-472-3006",
"fax_number": "253-472-3011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3820 PACIFIC AVE",
"address_2": "SUITE 101",
"city": "TACOMA",
"state": "WA",
"postal_code": "984187825",
"telephone_number": "253-472-3006",
"fax_number": "253-472-3011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROBST",
"first_name": "SCOTT",
"middle_name": "S",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-29",
"last_updated": "2011-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "9475DDS",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE 60178653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.