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General NPI Number Information
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NPI Number | 1669079257
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Entity Type | Organization
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Legal Business Name | CHARLES F SCANLON II DDS MSD PC
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 1761 TABLEROCK RD
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City | RAPID CITY
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State | SD
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Zip | 57701-5595
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Country | US
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Telephone | 605-721-1111
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Fax | 605-721-1141
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Provider Business Mailing Address
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Address Line | 1761 TABLEROCK RD
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City | RAPID CITY
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State | SD
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Zip | 57701-5595
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Country | US
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Telephone | 605-721-1111
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Fax | 605-721-1141
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | MRS. KELSEY T LOWE
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Credential |
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Telephone | 605-721-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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