Provider Demographics
NPI:1568611374
Name:SCANLON, CHARLES F II (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:SCANLON
Suffix:II
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 SOUTH HIGHWAY 16
Mailing Address - Street 2:SUITE A
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8911
Mailing Address - Country:US
Mailing Address - Phone:605-721-1111
Mailing Address - Fax:
Practice Address - Street 1:5955 SOUTH HIGHWAY 16
Practice Address - Street 2:SUITE A
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8911
Practice Address - Country:US
Practice Address - Phone:605-721-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44921223G0001X
SDD09681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice