Healthcare Provider Details

I. General information

NPI: 1255454310
Provider Name (Legal Business Name): STANLEY THOMAS SCALF DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 BOSTON SQ
GEORGETOWN KY
40324-9787
US

IV. Provider business mailing address

402 BOSTON SQ
GEORGETOWN KY
40324-9787
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-9340
  • Fax: 502-867-2049
Mailing address:
  • Phone: 502-863-9340
  • Fax: 502-867-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5966
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: