Provider Demographics
NPI:1124581905
Name:SCOTT A. JANSE, D.D.S., M.S., P.A.
Entity Type:Organization
Organization Name:SCOTT A. JANSE, D.D.S., M.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-342-2444
Mailing Address - Street 1:601 NW LOOP 410 STE 455
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5511
Mailing Address - Country:US
Mailing Address - Phone:210-342-2444
Mailing Address - Fax:210-342-2443
Practice Address - Street 1:1014 PARIS ST STE C
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-2956
Practice Address - Country:US
Practice Address - Phone:830-538-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT A. JANSE, D.D.S., M.S., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty