Basic Information
Provider Information
NPI: 1033557780
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THEWS
FirstName: SCOTT
MiddleName: G
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2611 PROMENADE PKWY
Address2:  
City: MIDLOTHIAN
State: VA
PostalCode: 231131431
CountryCode: US
TelephoneNumber: 8047946900
FaxNumber: 8047947974
Practice Location
Address1: 2611 PROMENADE PKWY
Address2:  
City: MIDLOTHIAN
State: VA
PostalCode: 231131431
CountryCode: US
TelephoneNumber: 8047946900
FaxNumber: 8047947974
Other Information
ProviderEnumerationDate: 06/04/2013
LastUpdateDate: 06/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X0401411077VAY Dental ProvidersDentistGeneral Practice

No ID Information.


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