Provider Demographics
NPI:1619995230
Name:SCANLON, BARBARA TAIPALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:TAIPALE
Last Name:SCANLON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAIN ST.
Mailing Address - Street 2:P.O. BOX 1047
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-1047
Mailing Address - Country:US
Mailing Address - Phone:508-476-3115
Mailing Address - Fax:508-476-3214
Practice Address - Street 1:341 MAIN ST.
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:MA
Practice Address - Zip Code:01516-1047
Practice Address - Country:US
Practice Address - Phone:508-476-3115
Practice Address - Fax:508-476-3214
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042975145 001OtherDELTA DENTAL OF MASSACHUS
MAX05812OtherBCBS OF MASSACHUSETTS