Provider Demographics
NPI:1306512561
Name:SCOTT PYO, DDS INC
Entity type:Organization
Organization Name:SCOTT PYO, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:PYO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-499-4500
Mailing Address - Street 1:11230 GOLD EXPRESS DR STE 302
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4484
Mailing Address - Country:US
Mailing Address - Phone:916-638-8778
Mailing Address - Fax:
Practice Address - Street 1:11230 GOLD EXPRESS DR STE 302
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4484
Practice Address - Country:US
Practice Address - Phone:916-638-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental