Provider Demographics
NPI:1851446744
Name:RICHARD M. SCANLON, D.M.D
Entity Type:Organization
Organization Name:RICHARD M. SCANLON, D.M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-242-2731
Mailing Address - Street 1:27 SANDY LANE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1320
Mailing Address - Country:US
Mailing Address - Phone:717-242-2731
Mailing Address - Fax:
Practice Address - Street 1:27 SANDY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1320
Practice Address - Country:US
Practice Address - Phone:717-242-2731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-018602-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty