MEDICARE: DR. SCOTT W PODLESH 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	40294	CA

General Provider Information

NPI Number	:	1861455917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT W PODLESH DDS

Provider Business Mailing Address
First Line	:	1400 REDWOOD DR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-7248
Country	:	US
Telephone Number	:	650-969-7860
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 SCOTT BLVD
Second Line	:	SUITE 1
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5255
Country	:	US
Telephone Number	:	408-243-2300
Fax Number	:	408-243-2302

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/08/2007

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