Provider Demographics
NPI:1265009344
Name:SCANNELL, GERARD F III
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:F
Last Name:SCANNELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 CLEVELAND STREET
Mailing Address - Street 2:SUITE 252
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3243
Mailing Address - Country:US
Mailing Address - Phone:727-461-9149
Mailing Address - Fax:727-446-8382
Practice Address - Street 1:7000 66TH STREET NORTH
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4067
Practice Address - Country:US
Practice Address - Phone:727-546-4665
Practice Address - Fax:727-548-7684
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN258731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice