Healthcare Provider Details

I. General information

NPI: 1447478599
Provider Name (Legal Business Name): SCOTT GOULD NEWHART, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR SUITE #311
BEVERLY HILLS CA
90210-4322
US

IV. Provider business mailing address

416 N BEDFORD DR SUITE #311
BEVERLY HILLS CA
90210-4322
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-1533
  • Fax: 310-274-9756
Mailing address:
  • Phone: 310-550-1533
  • Fax: 310-274-9756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30611
License Number StateCA

VIII. Authorized Official

Name: LYNN NEWHART
Title or Position: VICE-PRESIDENT
Credential:
Phone: 310-550-1533