Provider Demographics
NPI:1679545404
Name:HAROLD JOHN SCANLON DDS PC
Entity type:Organization
Organization Name:HAROLD JOHN SCANLON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-921-4333
Mailing Address - Street 1:4585 WASHINGTON ST
Mailing Address - Street 2:STE A3
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5858
Mailing Address - Country:US
Mailing Address - Phone:314-921-4333
Mailing Address - Fax:314-921-8632
Practice Address - Street 1:3004 S SAINT PETERS PKWY
Practice Address - Street 2:SUITE I
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-6354
Practice Address - Country:US
Practice Address - Phone:636-441-1020
Practice Address - Fax:636-441-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty