Provider Demographics
NPI:1598966004
Name:WEST, SCOTT E (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:WEST
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 1:22672 LAMBERT ST
Mailing Address - Street 2:#603
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1613
Mailing Address - Country:US
Mailing Address - Phone:949-829-6700
Mailing Address - Fax:949-770-8336
Practice Address - Street 1:22672 LAMBERT ST
Practice Address - Street 2:#603
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1613
Practice Address - Country:US
Practice Address - Phone:949-829-6700
Practice Address - Fax:949-770-8336
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6201180001Medicare NSC