Healthcare Provider Details

I. General information

NPI: 1033223565
Provider Name (Legal Business Name): SOPHIA L SCANTLEBURY D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLAZA ST E STE 1H
BROOKLYN NY
11238-4954
US

IV. Provider business mailing address

10 PLAZA ST E STE 1H
BROOKLYN NY
11238-4954
US

V. Phone/Fax

Practice location:
  • Phone: 718-230-5046
  • Fax:
Mailing address:
  • Phone: 718-230-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number049279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: