Provider Demographics
NPI:1942611728
Name:DOUGLAS K SCALES, D.M.D., P.A.
Entity Type:Organization
Organization Name:DOUGLAS K SCALES, D.M.D., P.A.
Other - Org Name:ISLAND DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCALES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-278-7567
Mailing Address - Street 1:4689 US HIGHWAY 17
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4831
Mailing Address - Country:US
Mailing Address - Phone:904-278-7567
Mailing Address - Fax:904-278-7632
Practice Address - Street 1:4689 US HIGHWAY 17
Practice Address - Street 2:SUITE 6
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4831
Practice Address - Country:US
Practice Address - Phone:904-278-7567
Practice Address - Fax:904-278-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty