Healthcare Provider Details

I. General information

NPI: 1306791223
Provider Name (Legal Business Name): SCOTT KALOUST, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 ROYAL DR
CAMERON PARK CA
95682-8506
US

IV. Provider business mailing address

1300 UNIVERSITY DR STE 2
MENLO PARK CA
94025-4254
US

V. Phone/Fax

Practice location:
  • Phone: 530-677-1769
  • Fax:
Mailing address:
  • Phone: 650-274-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SCOTT KALOUST
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 650-274-7455