Provider Demographics
NPI:1679646400
Name:JASON A. SCORZA, D.D.S. AND HEATHER R. SMITH, D.D.S., A.D.C.
Entity Type:Organization
Organization Name:JASON A. SCORZA, D.D.S. AND HEATHER R. SMITH, D.D.S., A.D.C.
Other - Org Name:STANFORD RANCH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCORZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-435-4222
Mailing Address - Street 1:5800 STANFORD RANCH RD
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4385
Mailing Address - Country:US
Mailing Address - Phone:916-435-4222
Mailing Address - Fax:916-435-4777
Practice Address - Street 1:5800 STANFORD RANCH RD
Practice Address - Street 2:SUITE # 110
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4385
Practice Address - Country:US
Practice Address - Phone:916-435-4222
Practice Address - Fax:916-435-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1449419OtherUNITED CONCORDIA
CA1782454OtherUNITED CONCORDIA
CA1360401OtherUNITED CONDORDIA