Provider Demographics
NPI:1952648354
Name:NICHOLAS SCOTT ST. GEORGE, DDS, INC.
Entity Type:Organization
Organization Name:NICHOLAS SCOTT ST. GEORGE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ST. GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-927-2602
Mailing Address - Street 1:10249 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2362
Mailing Address - Country:US
Mailing Address - Phone:562-927-2602
Mailing Address - Fax:562-928-9232
Practice Address - Street 1:10249 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2362
Practice Address - Country:US
Practice Address - Phone:562-927-2602
Practice Address - Fax:562-928-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57614261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental