Provider Demographics
NPI:1033209101
Name:SCANNELL, BERTRAND E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERTRAND
Middle Name:E
Last Name:SCANNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PEACHTREE ST
Mailing Address - Street 2:SUITE LL150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3201
Mailing Address - Country:US
Mailing Address - Phone:404-525-2741
Mailing Address - Fax:404-589-0043
Practice Address - Street 1:303 PEACHTREE ST
Practice Address - Street 2:SUITE LL150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3201
Practice Address - Country:US
Practice Address - Phone:404-525-2741
Practice Address - Fax:404-589-0043
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA092891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice