Provider Demographics
NPI:1114247822
Name:EDWARD F. SCAMMON DMD PA
Entity Type:Organization
Organization Name:EDWARD F. SCAMMON DMD PA
Other - Org Name:HOMETOWN FAMILY DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:SCAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-826-4900
Mailing Address - Street 1:115 SOUTHERN DUNES DR
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9218
Mailing Address - Country:US
Mailing Address - Phone:910-693-8030
Mailing Address - Fax:910-693-8006
Practice Address - Street 1:115 SOUTHERN DUNES DR
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-9218
Practice Address - Country:US
Practice Address - Phone:910-693-8030
Practice Address - Fax:910-693-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty