1528391182 NPI number — DR. SCOTT ASHLEY WARDWELL D D S

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528391182 NPI number — DR. SCOTT ASHLEY WARDWELL D D S

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WARDWELL

Provider First Name:

SCOTT

Provider Middle Name:

ASHLEY

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

D D S

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1528391182

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/19/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1150 S KING ST STE 601

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HONOLULU

Provider Business Mailing Address State Name:

HI

Provider Business Mailing Address Postal Code:

96814-1952

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

808-946-0713

Provider Business Mailing Address Fax Number:

808-942-2661

Provider First Line Business Practice Location Address:

1150 S KING ST STE 601

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HONOLULU

Provider Business Practice Location Address State Name:

HI

Provider Business Practice Location Address Postal Code:

96814-1952

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

808-946-0713

Provider Business Practice Location Address Fax Number:

808-942-2661

Provider Enumeration Date:

09/15/2009

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1223G0001X , with the licence number:  DDS38942 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 1223G0001X , with the licence number: DT1848 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: A58238 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "GEHA" identifier . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "USA DELTA" identifier . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "GUARDIAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 793732 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "HAWAII DENTAL SERVICE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: A58238 . This is a "HAWAII MEDICAL SERVICE ASSOC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "METLIFE" identifier . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "HMAA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
• Identifier: 91848 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".