Provider Demographics
NPI:1093845406
Name:SCRIMALLI, CHARLES EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EUGENE
Last Name:SCRIMALLI
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 1:358 HAMLIN HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-0000
Mailing Address - Country:US
Mailing Address - Phone:570-689-2449
Mailing Address - Fax:866-658-1522
Practice Address - Street 1:RTE 590 AT 348
Practice Address - Street 2:HAMLIN PROFESSIONAL COMPLEX
Practice Address - City:HAMLIN
Practice Address - State:PA
Practice Address - Zip Code:18427
Practice Address - Country:US
Practice Address - Phone:570-689-2449
Practice Address - Fax:570-689-0960
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024178L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist