Provider Demographics
NPI:1699946525
Name:PODELL, SCOTT WILLIAM (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:PODELL
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 POMPTON AVE
Mailing Address - Street 2:B1
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1266
Mailing Address - Country:US
Mailing Address - Phone:973-239-5600
Mailing Address - Fax:
Practice Address - Street 1:878 POMPTON AVE
Practice Address - Street 2:B1
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1266
Practice Address - Country:US
Practice Address - Phone:973-239-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01277600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist