Healthcare Provider Details

I. General information

NPI: 1902817851
Provider Name (Legal Business Name): DRS. SCULLY, MATHESON AND FONSECA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
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 Number
License Number StateNC

VIII. Authorized Official

Name: JOHN ROBERT SCULLY
Title or Position: PRESIDENT
Credential: D.D.S.,M.S.
Phone: 828-255-7781