Provider Demographics
NPI:1689887291
Name:KALOUST, SCOTT W (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:KALOUST
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 ELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1617
Mailing Address - Country:US
Mailing Address - Phone:650-364-2728
Mailing Address - Fax:
Practice Address - Street 1:1300 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4203
Practice Address - Country:US
Practice Address - Phone:650-326-0250
Practice Address - Fax:650-326-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA424751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics