Healthcare Provider Details

I. General information

NPI: 1659389328
Provider Name (Legal Business Name): JOHN ROBERT SCULLY D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ROCKCLIFF PL
ASHEVILLE NC
28801-4510
US

IV. Provider business mailing address

5 ROCKCLIFF PL
ASHEVILLE NC
28801-4510
US

V. Phone/Fax

Practice location:
  • Phone: 828-255-7781
  • Fax: 828-258-3770
Mailing address:
  • Phone: 828-255-7781
  • Fax: 828-258-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: