Provider Demographics
NPI:1023237989
Name:SCARLETT, GARY THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:THOMAS
Last Name:SCARLETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:151 SAWGRASS CORNERS DR
Mailing Address - Street 2:STE 102
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3553
Mailing Address - Country:US
Mailing Address - Phone:904-543-0568
Mailing Address - Fax:904-543-2954
Practice Address - Street 1:151 SAWGRASS CORNERS DR
Practice Address - Street 2:STE 102
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3553
Practice Address - Country:US
Practice Address - Phone:904-543-0568
Practice Address - Fax:904-543-2954
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN136851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL453342139OtherTAX ID NUMBER