Provider Demographics
NPI:1225184880
Name:SCIALFA, AUGUST JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:JOSEPH
Last Name:SCIALFA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:AJ
Other - Middle Name:TONY
Other - Last Name:SCIALFA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2540 PEBBLE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1647
Mailing Address - Country:US
Mailing Address - Phone:041-629-4686
Mailing Address - Fax:
Practice Address - Street 1:1872 TAMIAMI TRL S
Practice Address - Street 2:SUITE C
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3129
Practice Address - Country:US
Practice Address - Phone:941-492-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist