MEDICARE: SCOTT A AND JULIE H FORD, D.D.S., INC

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	122300000X	Dentist	28151	CA
2	122300000X	Dentist	28714	CA

General Provider Information

NPI Number	:	1659397206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT A AND JULIE H FORD, D.D.S., INC

Provider Business Mailing Address
First Line	:	16511 GOLDENWEST ST
Second Line	:	SUITE D
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4484
Country	:	US
Telephone Number	:	714-842-7431
Fax Number	:

Provider Business Practice Location Address
First Line	:	16511 GOLDENWEST ST
Second Line	:	SUITE D
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4484
Country	:	US
Telephone Number	:	714-842-7431
Fax Number	:

Authorized Official
Title or Position	:	SECRETARU
Name	:	DR. JULIE H FORD
Credential	:	DDS
Telephone Number	:	714-842-7431

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	08/22/2020

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