Provider Demographics
NPI:1649437195
Name:SCOTT A WARDWELL D D S INC
Entity type:Organization
Organization Name:SCOTT A WARDWELL D D S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:808-946-0713
Mailing Address - Street 1:1150 S KING ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1952
Mailing Address - Country:US
Mailing Address - Phone:808-946-0713
Mailing Address - Fax:808-942-2661
Practice Address - Street 1:1150 S KING ST STE 601
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1952
Practice Address - Country:US
Practice Address - Phone:808-946-0713
Practice Address - Fax:808-942-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS38942122300000X
HIDT1848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI91848OtherHAWAII DENTAL SERVICE
91848OtherGEHA
91848OtherGUARDIAN
91848OtherCIGNA
A58238OtherBLUE CROSS BLUE SHIELD
91848OtherMETLIFE
HIA58238OtherHAWAII MED SERVICE ASSOC
793732OtherUNITED CONCORDIA
91848OtherAETNA
91848OtherUNITED HEALTHCARE
91848OtherUSA DELTA
HI91848OtherHMAA