Provider Demographics
NPI:1053778340
Name:SCOTT DAVID SCHAPANSKY D.D.S. INC.
Entity type:Organization
Organization Name:SCOTT DAVID SCHAPANSKY D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHAPANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-832-8211
Mailing Address - Street 1:4911 N DEL MAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-3327
Mailing Address - Country:US
Mailing Address - Phone:559-832-8211
Mailing Address - Fax:
Practice Address - Street 1:4911 N DEL MAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-3327
Practice Address - Country:US
Practice Address - Phone:559-301-0372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60685251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA60685OtherCALIFORNIA DENTAL LICENSE