Provider Demographics
NPI:1093929408
Name:SCALA, MICHELLE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:SCALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:SCALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1805 BAYSHORE GARDENS PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4706
Mailing Address - Country:US
Mailing Address - Phone:941-755-6477
Mailing Address - Fax:941-755-4737
Practice Address - Street 1:1805 BAYSHORE GARDENS PKWY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4706
Practice Address - Country:US
Practice Address - Phone:941-755-6477
Practice Address - Fax:941-755-4737
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist