Provider Demographics
NPI:1346352218
Name:SCANNURA, LOUIS DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:DENNIS
Last Name:SCANNURA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 FAIRVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-9455
Mailing Address - Country:US
Mailing Address - Phone:217-529-7016
Mailing Address - Fax:
Practice Address - Street 1:3007 SPRING MILL DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6558
Practice Address - Country:US
Practice Address - Phone:217-546-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL787271Medicare PIN
IL787280Medicare ID - Type UnspecifiedMEDICARE NUMBER
ILT38582Medicare UPIN