Provider Demographics
NPI:1598010506
Name:SCOTT C. HALLSTED, D.D.S., INC
Entity Type:Organization
Organization Name:SCOTT C. HALLSTED, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALLSTED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-343-1104
Mailing Address - Street 1:500 PRIMROSE ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4088
Mailing Address - Country:US
Mailing Address - Phone:650-343-1104
Mailing Address - Fax:650-343-0772
Practice Address - Street 1:500 PRIMROSE ROAD
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4088
Practice Address - Country:US
Practice Address - Phone:650-343-1104
Practice Address - Fax:650-343-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23190332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment