Provider Demographics
NPI:1922097674
Name:SCANLON, JOHN FRANCIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:SCANLON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:13 JOB CUSHING RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2332
Mailing Address - Country:US
Mailing Address - Phone:508-842-3636
Mailing Address - Fax:508-869-2910
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1948
Practice Address - Country:US
Practice Address - Phone:508-869-6388
Practice Address - Fax:508-869-2910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA144151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14415OtherSTATE LICENSE