Healthcare Provider Details

I. General information

NPI: 1508966375
Provider Name (Legal Business Name): ARTHUR RODDY SCARBROUGH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BAY AVE
RICHTON MS
39476-0547
US

IV. Provider business mailing address

PO BOX 547 205 BAY AVE
RICHTON MS
39476-0547
US

V. Phone/Fax

Practice location:
  • Phone: 601-788-9374
  • Fax: 601-788-9374
Mailing address:
  • Phone: 601-788-9374
  • Fax: 601-788-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2572-90
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number005202
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: