Provider Demographics
NPI:1669079257
Name:CHARLES F SCANLON II DDS MSD PC
Entity type:Organization
Organization Name:CHARLES F SCANLON II DDS MSD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-721-1111
Mailing Address - Street 1:1761 TABLEROCK RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5595
Mailing Address - Country:US
Mailing Address - Phone:605-721-1111
Mailing Address - Fax:605-721-1141
Practice Address - Street 1:1761 TABLEROCK RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-5595
Practice Address - Country:US
Practice Address - Phone:605-721-1111
Practice Address - Fax:605-721-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty