Provider Demographics
NPI:1295877363
Name:JOHN SCALETTA D.D.S.LTD.
Entity type:Organization
Organization Name:JOHN SCALETTA D.D.S.LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCALETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-743-7792
Mailing Address - Street 1:N1005 RESEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-6627
Mailing Address - Country:US
Mailing Address - Phone:715-743-7792
Mailing Address - Fax:
Practice Address - Street 1:808 WEST FIFTH ST.
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-0067
Practice Address - Country:US
Practice Address - Phone:715-743-3293
Practice Address - Fax:715-743-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4308-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty