MEDICARE: SCOTT W. NIVEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1285336024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT W. NIVEN DDS

Provider Business Mailing Address
First Line	:	2001 WESTCLIFF DR STE 202
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5552
Country	:	US
Telephone Number	:	949-752-6733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 WESTCLIFF DR STE 202
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5552
Country	:	US
Telephone Number	:	949-752-6733
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING TEAM LEAD
Name	:	PAOLA RAMOS
Credential	:
Telephone Number	:	972-869-3789

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	09/30/2024

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