Provider Demographics
NPI:1598982589
Name:MARK R. SCILLEY, DDS, PC
Entity Type:Organization
Organization Name:MARK R. SCILLEY, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-834-0890
Mailing Address - Street 1:855 E BROWN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4958
Mailing Address - Country:US
Mailing Address - Phone:480-834-0890
Mailing Address - Fax:480-964-3175
Practice Address - Street 1:855 E BROWN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4958
Practice Address - Country:US
Practice Address - Phone:480-834-0890
Practice Address - Fax:480-964-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty