Provider Demographics
NPI:1346681137
Name:SCALLON, MARK JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:SCALLON
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 1:909 LINCOLN CIR SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1861
Mailing Address - Country:US
Mailing Address - Phone:712-737-4177
Mailing Address - Fax:712-737-8718
Practice Address - Street 1:909 LINCOLN CIR SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1861
Practice Address - Country:US
Practice Address - Phone:712-737-4177
Practice Address - Fax:712-737-8718
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-090161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice