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General NPI Number Information
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NPI Number | 1154506343
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Entity Type | Individual
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Provider Name | SCOTT DAVID FONG DMD
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Gender | Male
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 12677 ALCOSTA BLVD STE 570
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City | SAN RAMON
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State | CA
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Zip | 94583-4423
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Country | US
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Telephone | 925-820-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 12677 ALCOSTA BLVD STE 570
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City | SAN RAMON
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State | CA
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Zip | 94583-4423
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Country | US
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Telephone | 925-820-2868
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Fax | 925-820-2868
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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 | CA38522
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License Number State | CA
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