Provider Demographics
NPI:1871584607
Name:C ELAM SCULL III DDS INC
Entity type:Organization
Organization Name:C ELAM SCULL III DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ELAM
Authorized Official - Last Name:SCULL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:830-379-8722
Mailing Address - Street 1:309 N MILAM ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5514
Mailing Address - Country:US
Mailing Address - Phone:830-379-8722
Mailing Address - Fax:830-379-8728
Practice Address - Street 1:309 N MILAM ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5514
Practice Address - Country:US
Practice Address - Phone:830-379-8722
Practice Address - Fax:830-379-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty