Provider Demographics
NPI:1407119894
Name:SCALES, BERNICE (DDS)
Entity Type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:
Last Name:SCALES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 LELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909
Mailing Address - Country:US
Mailing Address - Phone:706-955-8789
Mailing Address - Fax:
Practice Address - Street 1:36 CHEATHAM STREET
Practice Address - Street 2:WADLEY DENTAL CENTER
Practice Address - City:WADLEY
Practice Address - State:GA
Practice Address - Zip Code:30477
Practice Address - Country:US
Practice Address - Phone:478-252-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist