Provider Demographics
NPI:1245451582
Name:KUBOTA, SCOTT STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:STEVEN
Last Name:KUBOTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 WESTWOOD BLVD
Mailing Address - Street 2:#250
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8404
Mailing Address - Country:US
Mailing Address - Phone:310-475-1667
Mailing Address - Fax:310-475-1697
Practice Address - Street 1:1964 WESTWOOD BLVD
Practice Address - Street 2:#250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8404
Practice Address - Country:US
Practice Address - Phone:310-475-1667
Practice Address - Fax:310-475-1697
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist