Organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Active
Organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Active
Other names
Indian Health Center of Santa Clara Valley - Forest Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALDON WAYNE SCOTT DM (DIRECTOR OF OPERATIONS)
(408) 445-3400
Entity
Organization
Contact information
Practice address
2039 FOREST AVE STE 204B, SAN JOSE, CA 95128-4815
(408) 445-3400
Mailing address
1333 MERIDIAN AVE, SAN JOSE, CA 95125-5212
(408) 445-3400
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
070000118
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1137
MEDICARE PALMETTO
CA
01
—
FHC11833F
STATE PROGRAM
CA
05
—
FHC11833F
—
CA
Enumeration date
09/20/2016
Last updated
09/20/2016
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