Active NPI
Scott Gavin Ewing, D.D.S.
- Dentist
- Pleasanton, CA
National Provider Identifier
1528485190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 64781
- Practice address
- 6654 Koll Center Pkwy
#350
Pleasanton, CA 94566 - Phone
- (925) 484-2828
- Fax
- (925) 484-4504
- NPI assigned
- Mar 21, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | CA | ||
| Dentist | 122300000X | 64781 | CA | Primary |
Addresses
Primary practice location
6654 Koll Center Pkwy
#350
Pleasanton, CA 94566
Mailing address
6654 Koll Center Pkwy
#350
Pleasanton, CA 94566
Phone (925) 484-2828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64781 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Koll Center Dental Group | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Pleasanton, CA
- NPI 1316188436
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1395360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466985600000",
"number": "1528485190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6654 KOLL CENTER PKWY",
"address_2": "#350",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "94566",
"telephone_number": "925-484-2828",
"fax_number": "925-484-4504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6654 KOLL CENTER PKWY",
"address_2": "#350",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "94566",
"telephone_number": "925-484-2828",
"fax_number": "925-484-4504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EWING",
"first_name": "SCOTT",
"middle_name": "GAVIN",
"name_prefix": "Mr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-03-21",
"last_updated": "2016-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "64781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.