=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497971592
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL S SCEROLER DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8050 WATSON CIRCLE
-----------------------------------------------------
City | DENHAM SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-665-3100
-----------------------------------------------------
Fax | 225-665-0616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 394
-----------------------------------------------------
City | WATSON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70786-0394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-665-3100
-----------------------------------------------------
Fax | 225-665-0616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4908
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------