Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D4669-PD | ID |
NPI | 1003222506 |
---|---|
Provider Name | Scott Pickett |
First Address | Nampa, ID 83686-2856 |
Second Address | Nampa, ID 83686-2856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2014 |
Last Update Date | 16/11/2021 |