Provider Demographics
NPI:1558574129
Name:SCARBOROUGH, DAISY ELLEN (RDH BS)
Entity Type:Individual
Prefix:MS
First Name:DAISY
Middle Name:ELLEN
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W ELIZABETH STREET
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875
Mailing Address - Country:US
Mailing Address - Phone:410-845-1186
Mailing Address - Fax:
Practice Address - Street 1:1101 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-546-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5547124Q00000X
DEG20002593124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist