Healthcare Provider Details

I. General information

NPI: 1336268036
Provider Name (Legal Business Name): SCOTT C SCHWARTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1476 DEER PARK AVE SUITE 1
NORTH BABYLON NY
11703-1200
US

IV. Provider business mailing address

1476 DEER PARK AVE SUITE 1
NORTH BABYLON NY
11703-1200
US

V. Phone/Fax

Practice location:
  • Phone: 631-667-0070
  • Fax:
Mailing address:
  • Phone: 631-667-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number042633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: