Basic Information
| Provider Information | |||||||||
| NPI: | 1033557780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THEWS | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 0401411077 | VA | Y | Dental Providers | Dentist | General Practice |
No ID Information.