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General NPI Number Information
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NPI Number | 1114059854
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Entity Type | Individual
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Provider Name | SCOTT W PACKHAM DDS
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 450 ROSEWOOD AVE SUITE 105
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City | CAMARILLO
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State | CA
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Zip | 93010-5914
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Country | US
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Telephone | 805-484-1022
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Fax | 805-484-3221
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Provider Business Mailing Address
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Address Line | 450 ROSEWOOD AVE SUITE 105
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City | CAMARILLO
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State | CA
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Zip | 93010-5914
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Country | US
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Telephone | 805-484-1022
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Fax | 805-484-3221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38345
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License Number State | CA
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