Provider Demographics
NPI:1487628335
Name:SCALES, DOUGLAS KRISTOFER (DMD, PA)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KRISTOFER
Last Name:SCALES
Suffix:
Gender:M
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 US HIGHWAY 17
Mailing Address - Street 2:SUITE #6
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4831
Mailing Address - Country:US
Mailing Address - Phone:904-278-7567
Mailing Address - Fax:
Practice Address - Street 1:4689 US HIGHWAY 17
Practice Address - Street 2:SUITE #6
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4831
Practice Address - Country:US
Practice Address - Phone:904-278-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist