Provider Demographics
NPI:1528485190
Name:EWING, SCOTT GAVIN (DDS)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:GAVIN
Last Name:EWING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6654 KOLL CENTER PKWY
Mailing Address - Street 2:#350
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566
Mailing Address - Country:US
Mailing Address - Phone:925-484-2828
Mailing Address - Fax:925-484-4504
Practice Address - Street 1:6654 KOLL CENTER PKWY
Practice Address - Street 2:#350
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566
Practice Address - Country:US
Practice Address - Phone:925-484-2828
Practice Address - Fax:925-484-4504
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA64781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program