Provider Demographics
NPI:1902085921
Name:SCOTT AN, DDS,INC.
Entity Type:Organization
Organization Name:SCOTT AN, DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:AN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-419-6463
Mailing Address - Street 1:818 S ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2410
Mailing Address - Country:US
Mailing Address - Phone:213-804-5220
Mailing Address - Fax:
Practice Address - Street 1:10715 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-2113
Practice Address - Country:US
Practice Address - Phone:310-419-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48700261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental