Provider Demographics
NPI:1295857159
Name:ST ROMAIN, SCOTT A (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:ST ROMAIN
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 1:2300 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6216
Mailing Address - Country:US
Mailing Address - Phone:504-834-6504
Mailing Address - Fax:504-828-6145
Practice Address - Street 1:2300 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6216
Practice Address - Country:US
Practice Address - Phone:504-834-6504
Practice Address - Fax:504-828-6145
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
883249OtherUNITED CONCORDIA INS CO