Provider Demographics
NPI:1073704706
Name:SCAFFIDI, DAVID VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VICTOR
Last Name:SCAFFIDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 W ESPLANADE AVE STE 816
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2853
Mailing Address - Country:US
Mailing Address - Phone:504-468-6200
Mailing Address - Fax:504-468-6203
Practice Address - Street 1:1401 W ESPLANADE AVE STE 816
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2853
Practice Address - Country:US
Practice Address - Phone:504-468-6200
Practice Address - Fax:504-468-6203
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics