Provider Demographics
NPI:1174080147
Name:SCOTT A. JANSE, D.D.S., M.S., P.A.
Entity type:Organization
Organization Name:SCOTT A. JANSE, D.D.S., M.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:210-342-2444
Mailing Address - Street 1:601 NW LOOP 410 STE 455
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5511
Mailing Address - Country:US
Mailing Address - Phone:210-342-2444
Mailing Address - Fax:
Practice Address - Street 1:601 NW LOOP 410 STE 455
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5511
Practice Address - Country:US
Practice Address - Phone:210-342-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty