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General NPI Number Information
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NPI Number | 1437401098
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Entity Type | Organization
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Legal Business Name | NYASHA M. SCOTT DDS INC
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Dates
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Enumeration Date | 10/07/2012
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Last Update Date | 10/07/2012
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Provider Practice Location Address
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Address Line | 16465 SIERRA LAKES PKWY SUITE #255
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City | FONTANA
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State | CA
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Zip | 92336-1242
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Country | US
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Telephone | 909-350-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 16465 SIERRA LAKES PKWY SUITE 255
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City | FONTANA
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State | CA
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Zip | 92336-1242
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Country | US
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Telephone | 909-350-0770
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. NYASHA MICHELLE SCOTT
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Credential | DDS
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Telephone | 909-350-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 53105
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License Number State | CA
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