Provider Demographics
NPI:1306178124
Name:SCOTT A FISHMAN DDS INC.
Entity Type:Organization
Organization Name:SCOTT A FISHMAN DDS INC.
Other - Org Name:PEDIATRIC DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-927-6453
Mailing Address - Street 1:9818 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4408
Mailing Address - Country:US
Mailing Address - Phone:562-927-6453
Mailing Address - Fax:562-927-3400
Practice Address - Street 1:9818 PARAMOUNT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4408
Practice Address - Country:US
Practice Address - Phone:562-927-6453
Practice Address - Fax:562-927-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423111223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty