Provider Demographics
NPI:1336162684
Name:SCILLEY, MARK R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:SCILLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:855 E BROWN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-4958
Mailing Address - Country:US
Mailing Address - Phone:480-834-0890
Mailing Address - Fax:480-964-3175
Practice Address - Street 1:855 E BROWN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4958
Practice Address - Country:US
Practice Address - Phone:480-834-0890
Practice Address - Fax:480-964-3175
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist