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General NPI Number Information
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NPI Number | 1366779142
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Entity Type | Organization
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Legal Business Name | SCOTT GOULD NEWHART, DMD, INC.
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 301 ARIZONA AVE SUITE 300
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City | SANTA MONICA
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State | CA
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Zip | 90401-1394
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Country | US
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Telephone | 310-550-1533
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Fax | 310-394-3366
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Provider Business Mailing Address
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Address Line | 301 ARIZONA AVE SUITE 300
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City | SANTA MONICA
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State | CA
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Zip | 90401-1394
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Country | US
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Telephone | 310-550-1533
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Fax | 310-394-3366
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | LYNN NEWHART
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Credential |
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Telephone | 310-550-1533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30611
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License Number State | CA
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