Provider Demographics
NPI:1013015221
Name:SCHWARTZ, SCOTT ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:SCHWARTZ
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 1:8511 REGIS HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2336
Mailing Address - Country:US
Mailing Address - Phone:210-452-4498
Mailing Address - Fax:210-949-8906
Practice Address - Street 1:8410 DATAPOINT DR
Practice Address - Street 2:VA DENTAL CLINIC
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3220
Practice Address - Country:US
Practice Address - Phone:210-949-8900
Practice Address - Fax:210-949-8906
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
16624502OtherCIDC DENTAL
TX166245401Medicaid
1634811OtherUNITED CONCORDIA
88D945OtherBLUE CROSS BLUE SHIELD