Provider Demographics
NPI:1437386208
Name:MICHAEL J. SCOLES DMD RENTON LLC
Entity Type:Organization
Organization Name:MICHAEL J. SCOLES DMD RENTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-228-6444
Mailing Address - Street 1:300 PELLY AVE N
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5700
Mailing Address - Country:US
Mailing Address - Phone:425-228-6444
Mailing Address - Fax:425-226-3602
Practice Address - Street 1:300 PELLY AVE N
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5700
Practice Address - Country:US
Practice Address - Phone:425-228-6444
Practice Address - Fax:425-226-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9010122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty