Provider Demographics
NPI:1619007127
Name:SCANTLAN & ROWBOTTOM, D.D.S., P.C.
Entity Type:Organization
Organization Name:SCANTLAN & ROWBOTTOM, D.D.S., P.C.
Other - Org Name:MERAMEC DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCANTLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-468-2772
Mailing Address - Street 1:675 DUNSFORD DR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1267
Mailing Address - Country:US
Mailing Address - Phone:573-468-2774
Mailing Address - Fax:573-468-2008
Practice Address - Street 1:675 DUNSFORD DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-1267
Practice Address - Country:US
Practice Address - Phone:573-468-2774
Practice Address - Fax:573-468-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO147001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty