Doctor Name: | DR. BLAKE WILLIAM SCOTT |
NPI Number: | 1972714707 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.D.S. |
License Number: | |
Business Practice Address: | 13128 14th St First Dental Battalion Ndc Camp Pendleton, CA - 92055 |
Business Phone Number: | 7607255578 |
Business Fax Number: | |
Mailing Address: | 6333 La Jolla Blvd, Unit 271 LA JOLLA |
State: | CA |
Postal Code: | 920376615 |
Phone Number: | 4155176729 |
Fax Number: | |
NPI Enumeration Date: | 05/24/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |