Provider Demographics
NPI:1568978724
Name:SCOTT LUNDY, DDS, INC
Entity Type:Organization
Organization Name:SCOTT LUNDY, DDS, INC
Other - Org Name:WESTLAKE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-496-4247
Mailing Address - Street 1:176 AUBURN CT STE 5
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3682
Mailing Address - Country:US
Mailing Address - Phone:805-496-4247
Mailing Address - Fax:805-496-9830
Practice Address - Street 1:176 AUBURN CT STE 5
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3682
Practice Address - Country:US
Practice Address - Phone:805-496-4247
Practice Address - Fax:805-496-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61720261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1881944593Medicaid