MEDICARE: ANTHONY J. SCOMA, DDS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1215206198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY J. SCOMA, DDS INC.

Provider Business Mailing Address
First Line	:	12036 SCRIPPS HIGHLAND DR STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-5155
Country	:	US
Telephone Number	:	858-271-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	12036 SCRIPPS HIGHLAND DR STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-5155
Country	:	US
Telephone Number	:	858-271-4200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANTHONY J. SCOMA
Credential	:
Telephone Number	:	858-551-9700

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	08/19/2014

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