MEDICARE: DR. SCOTT WILLIAM PODELL DMD, MPH

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	22DI01277600	NJ

General Provider Information

NPI Number	:	1699946525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT WILLIAM PODELL DMD, MPH

Provider Business Mailing Address
First Line	:	878 POMPTON AVE
Second Line	:	B1
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1266
Country	:	US
Telephone Number	:	973-239-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	878 POMPTON AVE
Second Line	:	B1
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1266
Country	:	US
Telephone Number	:	973-239-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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