Provider Demographics
NPI:1407394430
Name:SCULLY, HARRIET KILGORE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:KILGORE
Last Name:SCULLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 COMMONS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4133
Mailing Address - Country:US
Mailing Address - Phone:864-224-6300
Mailing Address - Fax:
Practice Address - Street 1:1504 PARKINS MILL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3641
Practice Address - Country:US
Practice Address - Phone:864-982-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist