Provider Demographics
NPI:1326265463
Name:SCARBOROUGH, BRUCE MALCOLM (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MALCOLM
Last Name:SCARBOROUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4611
Mailing Address - Country:US
Mailing Address - Phone:601-446-8389
Mailing Address - Fax:601-445-8990
Practice Address - Street 1:306 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4611
Practice Address - Country:US
Practice Address - Phone:601-446-8389
Practice Address - Fax:601-445-8990
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2507-891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice