Healthcare Provider Details

I. General information

NPI: 1063417244
Provider Name (Legal Business Name): DONALD SCOTT NAVARRO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 WEDGEWOOD DR
MONTVILLE NJ
07045-9044
US

IV. Provider business mailing address

74 WEDGEWOOD DR
MONTVILLE NJ
07045-9044
US

V. Phone/Fax

Practice location:
  • Phone: 973-285-4062
  • Fax: 973-285-4140
Mailing address:
  • Phone: 973-285-4062
  • Fax: 973-285-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901009775
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: