Provider Demographics
NPI:1639186323
Name:SCALAS, JOHN GABRIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GABRIEL
Last Name:SCALAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 BLOOMFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2403
Mailing Address - Country:US
Mailing Address - Phone:714-827-4990
Mailing Address - Fax:714-827-8943
Practice Address - Street 1:9201 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2403
Practice Address - Country:US
Practice Address - Phone:714-827-4990
Practice Address - Fax:714-827-8943
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47559122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist